Provider Demographics
NPI:1215287248
Name:BRYDIE, STEPHANIE MICHELLE (AUD)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:MICHELLE
Last Name:BRYDIE
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3145 VIRGINIA BEACH BLVD STE 206
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-6950
Mailing Address - Country:US
Mailing Address - Phone:757-401-4796
Mailing Address - Fax:757-516-3179
Practice Address - Street 1:3145 VIRGINIA BEACH BLVD STE 206
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-6950
Practice Address - Country:US
Practice Address - Phone:757-401-4796
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-18
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2201001500231H00000X
VA2101001919237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist