Provider Demographics
NPI:1467706564
Name:BINFORD, SIMONE SADE (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:SIMONE
Middle Name:SADE
Last Name:BINFORD
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:MRS
Other - First Name:SIMONE
Other - Middle Name:
Other - Last Name:HARDAWAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC-SLP
Mailing Address - Street 1:5372 OLD VIRGINIA ST
Mailing Address - Street 2:B
Mailing Address - City:URBANNA
Mailing Address - State:VA
Mailing Address - Zip Code:23175-2179
Mailing Address - Country:US
Mailing Address - Phone:804-758-5250
Mailing Address - Fax:
Practice Address - Street 1:5604 VIRGINIA BEACH BLVD STE 101
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-5631
Practice Address - Country:US
Practice Address - Phone:757-455-5000
Practice Address - Fax:757-319-4142
Is Sole Proprietor?:No
Enumeration Date:2012-10-29
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202007494235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA49-78137Medicaid
VA49-6521OtherMEDICARE