Provider Demographics
NPI:1396289542
Name:NORONHA BRASIL, RAFAELA
Entity type:Individual
Prefix:
First Name:RAFAELA
Middle Name:
Last Name:NORONHA BRASIL
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 1:4231 MONUMENT WALL WAY
Mailing Address - Street 2:APT 357
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-8433
Mailing Address - Country:US
Mailing Address - Phone:434-270-2324
Mailing Address - Fax:
Practice Address - Street 1:333 W CORK ST
Practice Address - Street 2:SUITE 230
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-3870
Practice Address - Country:US
Practice Address - Phone:540-536-5263
Practice Address - Fax:540-536-5139
Is Sole Proprietor?:No
Enumeration Date:2016-12-07
Last Update Date:2017-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202008194235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist