Kaitlyn Shea Mellick, CF-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

SZ11697 Issued in FL

Practice address

107 Longwood Ave
Rockledge, FL 32955-2827

Phone

(321) 338-2419

Fax

(321) 301-4278

NPI assigned

Sep 15, 2023

Last updated

Sep 15, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1694736000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694736000000",
    "number": "1063290633",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "843 LAUREL DR",
            "city": "ROCKLEDGE",
            "state": "FL",
            "postal_code": "329554115",
            "telephone_number": "321-412-0051"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "107 LONGWOOD AVE",
            "city": "ROCKLEDGE",
            "state": "FL",
            "postal_code": "329552827",
            "telephone_number": "321-338-2419",
            "fax_number": "321-301-4278"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MELLICK",
        "first_name": "KAITLYN",
        "middle_name": "SHEA",
        "name_prefix": "Ms.",
        "credential": "CF-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-09-15",
        "last_updated": "2023-09-15",
        "certification_date": "2023-09-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "FL",
            "license": "SZ11697",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Speech-Language Pathologist in Rockledge, FL
• Providers in Rockledge, FL by specialty
• Speech-Language Pathologist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.