Active NPI
Amanda Davidson
- Speech-Language Pathologist
- Summerville, SC
National Provider Identifier
1033614789
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 6131
- Practice address
- 1801 Old Trolley Rd
Summerville, SC 29485-8283 - Phone
- (843) 871-3235
- NPI assigned
- Mar 26, 2018
- Last updated
- Mar 26, 2018
- Sex
- Female
- Sole proprietor
- No
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 | 6131 | SC | Primary |
Addresses
Primary practice location
1801 Old Trolley Rd
Summerville, SC 29485-8283
Mailing address
669 Edmonds Dr
Charleston, SC 29412-4540
Phone (843) 735-8778
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6131 | SC | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1522022400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1522022400000",
"number": "1033614789",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "669 EDMONDS DR",
"city": "CHARLESTON",
"state": "SC",
"postal_code": "294124540",
"telephone_number": "843-735-8778"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1801 OLD TROLLEY RD",
"city": "SUMMERVILLE",
"state": "SC",
"postal_code": "294858283",
"telephone_number": "843-871-3235"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVIDSON",
"first_name": "AMANDA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-03-26",
"last_updated": "2018-03-26",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "SC",
"license": "6131",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Summerville, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.