Active NPI
Donna Petersen
- Speech-Language Pathologist
- W Melbourne, FL
National Provider Identifier
1003480856
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- Practice address
- 2706 Bradfordt Dr
W Melbourne, FL 32904-7321 - Phone
- (321) 586-6488
- NPI assigned
- May 17, 2021
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | Primary |
Addresses
Primary practice location
2706 Bradfordt Dr
W Melbourne, FL 32904-7321
Mailing address
2706 Bradfordt Dr
W Melbourne, FL 32904-7321
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1621209600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1621209600000",
"number": "1003480856",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2706 BRADFORDT DR",
"city": "W MELBOURNE",
"state": "FL",
"postal_code": "329047321"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2706 BRADFORDT DR",
"city": "W MELBOURNE",
"state": "FL",
"postal_code": "329047321",
"telephone_number": "321-586-6488"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSEN",
"first_name": "DONNA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-05-17",
"last_updated": "2021-05-17",
"certification_date": "2021-05-17",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in W Melbourne, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.