Provider Demographics
NPI:1619580479
Name:RICHARDSON, CHEYANNE
Entity Type:Individual
Prefix:MRS
First Name:CHEYANNE
Middle Name:
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHEYANNE
Other - Middle Name:
Other - Last Name:BERENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:240 MUSTANG TRL STE 5
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-7516
Mailing Address - Country:US
Mailing Address - Phone:757-799-9951
Mailing Address - Fax:
Practice Address - Street 1:240 MUSTANG TRL STE 5
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-7516
Practice Address - Country:US
Practice Address - Phone:757-799-9951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-31
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2204000599235Z00000X
VA2202010092235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist