NPIMap

Organization Active NPI

Melanie Desmond

  • Speech-Language Pathologist
  • Ponte Vedra Beach, FL
National Provider Identifier
1104223395
Registry record updated Feb 22, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
Legal business name
MELANIE DESMOND
Practice address
128 Woodlands Creek Dr
Ponte Vedra Beach, FL 32082-3217
Phone
(904) 616-3455
NPI assigned
Dec 3, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 22, 2022

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

Authorized official

Name
Melanie P DesmondNPI 1720203078
Title
Owner
Phone
(904) 616-3455

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Developmental TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 222Q00000X
Speech-Language PathologistGroup: 193200000X MULTI-SPECIALTY GROUP 235Z00000X SA6650 FL
Speech-Language PathologistGroup: 193400000X SINGLE SPECIALTY GROUP 235Z00000X Primary

Addresses

Primary practice location

128 Woodlands Creek Dr
Ponte Vedra Beach, FL 32082-3217

Mailing address

128 Woodlands Creek Dr
Ponte Vedra Beach, FL 32082-3217
Phone (904) 616-3455

Other identifiers 1

IdentifierTypeStateIssuer
014138500MedicaidFL

Other names 1

  • Beaches Speech Therapy Doing business as

National Provider Directory

National Provider Directory

Locations

5150 Palm Valley Rd
Ponte Vedra Beach, FL 32082
Phone (904) 382-9790

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1417564800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1645488000000",
    "number": "1104223395",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "128 WOODLANDS CREEK DR",
            "city": "PONTE VEDRA BEACH",
            "state": "FL",
            "postal_code": "320823217",
            "telephone_number": "904-616-3455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "128 WOODLANDS CREEK DR",
            "city": "PONTE VEDRA BEACH",
            "state": "FL",
            "postal_code": "320823217",
            "telephone_number": "904-616-3455"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MELANIE DESMOND",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-12-03",
        "last_updated": "2022-02-22",
        "certification_date": "2022-02-22",
        "status": "A",
        "authorized_official_last_name": "DESMOND",
        "authorized_official_first_name": "MELANIE",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "904-616-3455"
    },
    "taxonomies": [
        {
            "code": "222Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Developmental Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": "FL",
            "license": "SA6650",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "014138500",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Beaches Speech Therapy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Beaches Speech Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ponte Vedra Beach, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2022; 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.