| Doctor Name: | MS. TRACEY ANN MEDEIROS |
| NPI Number: | 1972802163 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MS, CCC-SLP |
| License Number: | 2846 |
| Business Practice Address: | 620 John Paul Jones Cir Portsmouth, VA - 237082111 |
| Business Phone Number: | 7579532960 |
| Business Fax Number: | |
| Mailing Address: | Psc 103 Box 4859, APO |
| State: | AE |
| Postal Code: | 096030049 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 03/28/2011 |
| NPI Last Update Date: | 03/28/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | 2846 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NC |
| Taxonomy Type: | Speech, Language and Hearing Service Providers |
| Taxonomy Classification: | Speech-Language Pathologist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A speech pathologist is a person qualified by a master |