Desseret Funderburk, MS CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

7444 Issued in FL

Practice address

200 SE 12TH St
Pompano Beach, FL 33060-9217

Phone

(954) 643-7668

NPI assigned

Apr 13, 2023

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

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

{
    "created_epoch": "1681344000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1681344000000",
    "number": "1164118121",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 SE 12TH ST",
            "city": "POMPANO BEACH",
            "state": "FL",
            "postal_code": "330609217",
            "telephone_number": "954-643-7668"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 SE 12TH ST",
            "city": "POMPANO BEACH",
            "state": "FL",
            "postal_code": "330609217",
            "telephone_number": "954-643-7668"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FUNDERBURK",
        "first_name": "DESSERET",
        "credential": "MS CCC-SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-04-13",
        "last_updated": "2023-04-13",
        "certification_date": "2023-04-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "FL",
            "license": "7444",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Larry G Frydman, D.C.
• Nicole E S Frye
• Charlotte Felts Fudge, RN, BCBA
• Annette Fuller
• Sarah Ann Fulton
• Diana Furcht
• Allen Furia, MD
• Naomi D Furr
• Mariana Furtado, REGISTERED INTERN
• Ashlee Gaasch

• Speech-Language Pathologist in Pompano Beach, FL
• Providers in Pompano Beach, 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 Apr 13, 2023; 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.