Shanese Campbell, CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

SA20870 Issued in FL

Practice address

4008 SW 27TH St
West Park, FL 33023-4468

Phone

(954) 864-4511

NPI assigned

Oct 25, 2022

Last updated

Oct 25, 2022By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Enrolled in TX

Enrollment records 1

Specialty

Qualified Speech Language Pathologist

Education

Other, 2021

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Legacy Speech Services L.L.C.

  • Speech-Language Pathologist
  • Houston, TX
  • NPI 1427451145
  Medicare reassignment NPD
• New Horizons Speech & Language Therapy, LLC

  • Speech-Language Pathologist
  • West Park, FL
  • NPI 1720921026
  NPD Authorized official
• Legacy Speech Services L.L.C.

  • Home Health Agency
  • Houston, TX
  • NPI 1598329971
  NPD (past)

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

{
    "created_epoch": "1666656000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666656000000",
    "number": "1124745617",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4008 SW 27TH ST",
            "city": "WEST PARK",
            "state": "FL",
            "postal_code": "330234468",
            "telephone_number": "954-864-4511"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4008 SW 27TH ST",
            "city": "WEST PARK",
            "state": "FL",
            "postal_code": "330234468",
            "telephone_number": "954-864-4511"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CAMPBELL",
        "first_name": "SHANESE",
        "credential": "CCC-SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-10-25",
        "last_updated": "2022-10-25",
        "certification_date": "2022-10-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "FL",
            "license": "SA20870",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kery Anayansy Brooks Lopez
• Broward Community and Family Health Centers Inc
• Broward County (Broward Addiction Recovery Center)
• Maurice Bynum
• Amanda Calas Bolinaga
• Cardio-Wellness Center LLC
• Odalys Carmona Mena, RBT
• Ramon A Castillo Segura, RBT
• Nya Kai Caudell
• Victor Manuel Cedeno Garcia

• Speech-Language Pathologist in West Park, FL
• Providers in West Park, 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 Oct 25, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.