Provider Demographics
NPI:1093131294
Name:MOFFA, HOPE AMANDA (AUD)
Entity type:Individual
Prefix:DR
First Name:HOPE
Middle Name:AMANDA
Last Name:MOFFA
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:HOPE
Other - Middle Name:AMANDA
Other - Last Name:MIDDLEMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15243 FOREST RD STE D
Mailing Address - Street 2:
Mailing Address - City:FOREST
Mailing Address - State:VA
Mailing Address - Zip Code:24551-4974
Mailing Address - Country:US
Mailing Address - Phone:434-266-9898
Mailing Address - Fax:434-266-9848
Practice Address - Street 1:15243 FOREST RD STE D
Practice Address - Street 2:
Practice Address - City:FOREST
Practice Address - State:VA
Practice Address - Zip Code:24551-4974
Practice Address - Country:US
Practice Address - Phone:434-266-9898
Practice Address - Fax:434-266-9848
Is Sole Proprietor?:No
Enumeration Date:2014-03-12
Last Update Date:2024-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2101002049237600000X
VA2201001553231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1093131294Medicaid
VA1093131294Medicaid
VAQ50659BMedicare UPIN