Provider Demographics
NPI:1164005674
Name:MOORE, PAMELA PISONI
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:PISONI
Last Name:MOORE
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 1:10312 STEAMBOAT LANDING LN
Mailing Address - Street 2:
Mailing Address - City:BURKE
Mailing Address - State:VA
Mailing Address - Zip Code:22015-2542
Mailing Address - Country:US
Mailing Address - Phone:170-342-5339
Mailing Address - Fax:
Practice Address - Street 1:10312 STEAMBOAT LANDING LN
Practice Address - Street 2:
Practice Address - City:BURKE
Practice Address - State:VA
Practice Address - Zip Code:22015-2542
Practice Address - Country:US
Practice Address - Phone:170-342-5339
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-03
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202204640235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist