Active NPI
Marissa Nicole Peters
- Speech-Language Pathologist
- Fairport, NY
National Provider Identifier
1073046793
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 026586
- Practice address
- 36 Boxwood LN Apt 11
Fairport, NY 14450-3779 - Phone
- (609) 468-2835
- NPI assigned
- Apr 10, 2017
- 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 | 026586 | NY | Primary |
Addresses
Primary practice location
36 Boxwood LN Apt 11
Fairport, NY 14450-3779
Mailing address
36 Boxwood LN
Apt. 11
Fairport, NY 14450-3777
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 |
|---|---|---|---|
| 026586 | NY | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1491782400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1604880000000",
"number": "1073046793",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "36 BOXWOOD LN",
"address_2": "APT. 11",
"city": "FAIRPORT",
"state": "NY",
"postal_code": "144503777"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "36 BOXWOOD LN APT 11",
"city": "FAIRPORT",
"state": "NY",
"postal_code": "144503779",
"telephone_number": "609-468-2835"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERS",
"first_name": "MARISSA",
"middle_name": "NICOLE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-04-10",
"last_updated": "2020-11-09",
"certification_date": "2020-10-07",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "NY",
"license": "026586",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fairport, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 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.