Individual
MRS. MYRA MEDEIROS DAVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, CCC-SLP
Contact information
Practice address
601 CHILDREN'S LANE, NORFOLK, VA 23507
(757) 668-7000
Mailing address
1208 SMOKEY MOUNTAIN TRAIL, CHESAPEAKE, VA 23320-8150
(757) 548-3546
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
2202002413
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2202002413
VA SPEECH-LANGUAGE PATH
VA
Enumeration date
05/01/2007
Last updated
07/08/2007
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