Amanda Mizelle, M.S.CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

2980 Issued in NC

Practice address

35 Referendum Dr NE
Bolivia, NC 28422-7578

Phone

(910) 406-5100

Fax

(866) 293-0649

NPI assigned

Feb 28, 2007

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

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Pediatric Therapy Associates

  • Physical Therapist
  • Raleigh, NC
  • NPI 1447310958

  Speech-Language Pathologist

  NPD (past)

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

{
    "created_epoch": "1172620800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1774915200000",
    "number": "1124156435",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2003 E OAK ISLAND DR STE 4",
            "city": "OAK ISLAND",
            "state": "NC",
            "postal_code": "284656326",
            "telephone_number": "919-815-5046"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "35 REFERENDUM DR NE",
            "city": "BOLIVIA",
            "state": "NC",
            "postal_code": "284227578",
            "telephone_number": "910-406-5100",
            "fax_number": "866-293-0649"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIZELLE",
        "first_name": "AMANDA",
        "name_prefix": "Mrs.",
        "credential": "M.S.CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-28",
        "last_updated": "2026-03-31",
        "certification_date": "2026-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NC",
            "license": "2980",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7412516",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "018CV",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7212036",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Laura Ann McDaniel O'Connell, SLP
• Jennifer Lynn McGlynn, CCC-SLP
• McKeithan Health, PA
• Edward Marvin McKeithan, NP
• Lloyd Calhoun Meeks, M.D.
• Beverly Anne Montalvo, FNP
• Amanda Marie Montgomery, DPT
• Shakema Morgan
• Douglas R. Morgart, M.D.
• Josef N. Mueksch, MD MBA

• Speech-Language Pathologist in Bolivia, NC
• Providers in Bolivia, NC by specialty
• Speech-Language Pathologist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2026; 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.