Provider Demographics
NPI:1881935955
Name:MINNIS, DEBORAH (AUD)
Entity type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:
Last Name:MINNIS
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 COLISEUM DR
Mailing Address - Street 2:SUITE 120
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-5906
Mailing Address - Country:US
Mailing Address - Phone:757-827-2528
Mailing Address - Fax:757-827-2353
Practice Address - Street 1:4000 COLISEUM DR
Practice Address - Street 2:SUITE 120
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-5906
Practice Address - Country:US
Practice Address - Phone:757-827-2528
Practice Address - Fax:757-827-2353
Is Sole Proprietor?:No
Enumeration Date:2013-03-14
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2201000447231H00000X
VA2101000757237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist