Individual provider Active NPI

Donna Ann Fort-Brennan, SLP

  • Speech-Language Pathologist
  • Miller Place, NY
National Provider Identifier
1053689646
Registry record updated Dec 9, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
006335 Issued in NY
Practice address
76 Woodland Rd
Miller Place, NY 11764-1944
Phone
(631) 509-5551
NPI assigned
Dec 9, 2011
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 9, 2011

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 006335 NY Primary

Addresses

Primary practice location

76 Woodland Rd
Miller Place, NY 11764-1944

Mailing address

76 Woodland Rd
Miller Place, NY 11764-1944
Phone (631) 509-5551

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231005000712 NY Practitioner - Qualified Speech Language Pathologist 9830544295 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Qualified Speech Language Pathologist
Education
Other, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Epic Long IslandGroup PAC ID 7315835907, 43 clinicians

Practice addresses (Care Compare)

1500 Hempstead Tpke
East Meadow, NY 11554-1551
Phone 5167397733420

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
006335NYMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Epilepsy Foundation of L.I. CurrentSince Aug 12, 2023 Accepting new patients
Epic Long Island CurrentSince Aug 12, 2023 Accepting new patients

Locations

1500 Hempstead Tpke
East Meadow, NY 11554
Phone 51673977331420

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": "1323388800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1323388800000",
    "number": "1053689646",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "76 WOODLAND RD",
            "city": "MILLER PLACE",
            "state": "NY",
            "postal_code": "117641944",
            "telephone_number": "631-509-5551"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "76 WOODLAND RD",
            "city": "MILLER PLACE",
            "state": "NY",
            "postal_code": "117641944",
            "telephone_number": "631-509-5551"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FORT-BRENNAN",
        "first_name": "DONNA",
        "middle_name": "ANN",
        "name_prefix": "Mrs.",
        "credential": "SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-12-09",
        "last_updated": "2011-12-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NY",
            "license": "006335",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Miller Place, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.