Active NPI
Deborah Jean Mizerak, MS CCC-SLP MBA
- Speech-Language Pathologist
- Fort Myers, FL
National Provider Identifier
1053939405
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 18033
- Practice address
- 15101 Shell Point Blvd
Fort Myers, FL 33908-1694 - Phone
- (239) 466-1131
- NPI assigned
- Jul 13, 2020
- 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 | 18033 | FL | Primary |
Addresses
Primary practice location
15101 Shell Point Blvd
Fort Myers, FL 33908-1694
Mailing address
9331 Lakebend Preserve CT
Estero, FL 34135-8148
Phone (508) 789-9619
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
- Credentials
- Master of Business Administration, Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 18033 | FL | MD | Periodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1594598400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1594598400000",
"number": "1053939405",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9331 LAKEBEND PRESERVE CT",
"city": "ESTERO",
"state": "FL",
"postal_code": "341358148",
"telephone_number": "508-789-9619"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15101 SHELL POINT BLVD",
"city": "FORT MYERS",
"state": "FL",
"postal_code": "339081694",
"telephone_number": "239-466-1131"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MIZERAK",
"first_name": "DEBORAH",
"middle_name": "JEAN",
"credential": "MS CCC-SLP MBA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-07-13",
"last_updated": "2020-07-13",
"certification_date": "2020-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "FL",
"license": "18033",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Myers, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.