Provider Demographics
NPI:1396035952
Name:NEAL, AYESHA VICTORIA (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:AYESHA
Middle Name:VICTORIA
Last Name:NEAL
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:MS
Other - First Name:AYESHA
Other - Middle Name:VICTORIA
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:513 GLEN CANYON DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28303-3218
Mailing Address - Country:US
Mailing Address - Phone:910-447-9555
Mailing Address - Fax:844-833-5682
Practice Address - Street 1:513 GLEN CANYON DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-3218
Practice Address - Country:US
Practice Address - Phone:910-447-9555
Practice Address - Fax:844-833-5682
Is Sole Proprietor?:No
Enumeration Date:2011-04-15
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9386235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist