Deja Tatyana Bulluck

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

Practice address

1110 Herndon Pkwy Ste 205
Herndon, VA 20170-5547

Phone

(571) 305-1906

NPI assigned

Jun 12, 2023

Last updated

Jun 19, 2023By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1686528000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687132800000",
    "number": "1447934245",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6020 STODDARD CT APT 202",
            "city": "ALEXANDRIA",
            "state": "VA",
            "postal_code": "223155610",
            "telephone_number": "202-805-1057"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1110 HERNDON PKWY STE 205",
            "city": "HERNDON",
            "state": "VA",
            "postal_code": "201705547",
            "telephone_number": "571-305-1906"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6020 Stoddard Ct Apt 202",
            "address_purpose": "LOCATION",
            "city": "Alexandria",
            "state": "VA",
            "postal_code": "223155610",
            "country_code": "US",
            "telephone_number": "202-805-1057",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BULLUCK",
        "first_name": "DEJA",
        "middle_name": "TATYANA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-06-12",
        "last_updated": "2023-06-19",
        "certification_date": "2023-06-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Adam Brunkhorst
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• Stephanie Marie Budrock, DPT, PT
• Joy Bullin, M.D.
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• Michelle Cades-Loggia, LCSW

• Speech-Language Pathologist in Herndon, VA
• Providers in Herndon, VA by specialty
• Speech-Language Pathologist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.