Provider Demographics
NPI:1982403366
Name:FONDEUR ROBERTS, VIELKA A
Entity type:Individual
Prefix:
First Name:VIELKA
Middle Name:A
Last Name:FONDEUR ROBERTS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:234 BRONTE TRCE
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-7419
Mailing Address - Country:US
Mailing Address - Phone:917-586-6349
Mailing Address - Fax:
Practice Address - Street 1:4560 PRINCESS ANNE
Practice Address - Street 2:
Practice Address - City:VI
Practice Address - State:VA
Practice Address - Zip Code:23462-7419
Practice Address - Country:US
Practice Address - Phone:757-495-4211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-10
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0131002616224ZF0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224ZF0002XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantFeeding, Eating & Swallowing