Provider Demographics
NPI:1003428533
Name:SUNDERLAND, MADISON ASHLEE
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:ASHLEE
Last Name:SUNDERLAND
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 1:14148 SNICKERSVILLE DR
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20155-4451
Mailing Address - Country:US
Mailing Address - Phone:703-232-8679
Mailing Address - Fax:
Practice Address - Street 1:11150 FAIRFAX BLVD STE 500
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-5029
Practice Address - Country:US
Practice Address - Phone:201-983-9881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-17
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2204000467235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist