Provider Demographics
NPI:1689306995
Name:VELASQUEZ, MIRANDA BRITTANY
Entity type:Individual
Prefix:
First Name:MIRANDA
Middle Name:BRITTANY
Last Name:VELASQUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4308 STAR LN
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-2430
Mailing Address - Country:US
Mailing Address - Phone:301-525-1464
Mailing Address - Fax:
Practice Address - Street 1:8986 LORTON STATION BLVD
Practice Address - Street 2:
Practice Address - City:LORTON
Practice Address - State:VA
Practice Address - Zip Code:22079-4753
Practice Address - Country:US
Practice Address - Phone:571-616-9579
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-27
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2201001967231H00000X
231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist