Individual provider Active NPI

Sophia Ella Margaret McConnell

  • Speech-Language Pathologist
  • Virginia Beach, VA
National Provider Identifier
1649003369
Registry record updated Sep 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
2204001473 Issued in VA
Practice address
629 Phoenix Dr Ste 115
Virginia Beach, VA 23452-7392
Phone
(757) 261-4475
Fax
(757) 222-3156
NPI assigned
Aug 20, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 17, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X 2204001473 VA Primary

Addresses

Primary practice location

629 Phoenix Dr Ste 115
Virginia Beach, VA 23452-7392

Mailing address

629 Phoenix Dr Ste 115
Virginia Beach, VA 23452-7392
Phone (757) 261-4475

Other practice location 1

818 Newtown Rd
Virginia Beach, VA 23462-1116
Phone (757) 261-4475

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241010000336 VA Practitioner - Qualified Speech Language Pathologist 5799217105 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2204001473VAMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Sentara Therapy Solutions, LLC Speech-Language Pathologist CurrentSince Jul 25, 2024 Accepting new patients
Sentara Therapy Solutions, LLC Speech-Language Pathologist CurrentSince Jul 25, 2024 Accepting new patients

Locations

824 N Military Hwy
Ste 100
Norfolk, VA 23502
Phone (888) 236-2263

629 Phoenix Dr
Ste 115
Virginia Beach, VA 23452
Phone (757) 261-4475

984B Laskin Rd
Virginia Beach, VA 23451
Phone (757) 395-6900

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1724112000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726531200000",
    "number": "1649003369",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "629 PHOENIX DR STE 115",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234527392",
            "telephone_number": "757-261-4475",
            "fax_number": "757-222-3156"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "629 PHOENIX DR STE 115",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234527392",
            "telephone_number": "757-261-4475",
            "fax_number": "757-222-3156"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "818 Newtown Rd",
            "address_purpose": "LOCATION",
            "city": "Virginia Beach",
            "state": "VA",
            "postal_code": "234621116",
            "country_code": "US",
            "telephone_number": "757-261-4475",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MCCONNELL",
        "first_name": "SOPHIA",
        "middle_name": "ELLA MARGARET",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-08-20",
        "last_updated": "2024-09-17",
        "certification_date": "2024-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "VA",
            "license": "2204001473",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Virginia Beach, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.