Provider Demographics
NPI:1285163584
Name:ROYSTER, TARA MICHELLE (AUD)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:MICHELLE
Last Name:ROYSTER
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 1:3552 WOODLAKE DR
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-4670
Mailing Address - Country:US
Mailing Address - Phone:706-464-8853
Mailing Address - Fax:
Practice Address - Street 1:5657 COLUMBIA PIKE STE 100
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22041-2876
Practice Address - Country:US
Practice Address - Phone:703-533-8008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-08
Last Update Date:2017-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2201001217231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist