Active NPI
Anna Rudemiller Shadid, M.S., CCC-SLP
- Speech-Language Pathologist
- Cordova, TN
National Provider Identifier
1063904001
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 6761
- Practice address
- 146 Timber Creek Dr Ste 101
Cordova, TN 38018-4396 - Phone
- (704) 779-8933
- NPI assigned
- Jun 5, 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 200083 | AR | |
| Speech-Language Pathologist | 235Z00000X | 6761 | TN | Primary |
Addresses
Primary practice location
146 Timber Creek Dr Ste 101
Cordova, TN 38018-4396
Mailing address
146 Timber Creek Dr Ste 101
Cordova, TN 38018-4396
Phone (704) 779-8933
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 Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6761 | TN | MD | Pharmacist |
| 200083 | AR | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Jarvis Pediatric Therapy, Inc. | Past | Accepting new patients | |
| MTG2 | Speech-Language Pathologist | Past | Accepting new patients |
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.
-
- Speech-Language Pathologist
- Cordova, TN
- NPI 1396476081
-
- Specialist
- Springdale, AR
- NPI 1467561688
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1528156800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1736726400000",
"number": "1063904001",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "146 TIMBER CREEK DR STE 101",
"city": "CORDOVA",
"state": "TN",
"postal_code": "380184396",
"telephone_number": "704-779-8933"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "146 TIMBER CREEK DR STE 101",
"city": "CORDOVA",
"state": "TN",
"postal_code": "380184396",
"telephone_number": "704-779-8933"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHADID",
"first_name": "ANNA",
"middle_name": "RUDEMILLER",
"name_prefix": "Miss",
"credential": "M.S., CCC-SLP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-06-05",
"last_updated": "2025-01-13",
"certification_date": "2025-01-13",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "AR",
"license": "200083",
"primary": false
},
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "TN",
"license": "6761",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cordova, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.