Active NPI
Ann M Moffitt I, CCC-SLP
- Speech-Language Pathologist
- Fairport, NY
National Provider Identifier
1174614077
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 014292-1
- Practice address
- 16 Edendery Cir
Fairport, NY 14450-1013 - Phone
- (585) 737-8545
- NPI assigned
- Sep 27, 2006
- 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 | 014292-1 | NY | Primary |
Addresses
Primary practice location
16 Edendery Cir
Fairport, NY 14450-1013
Mailing address
16 Edendery Cir
Fairport, NY 14450-1013
Phone (585) 737-8545
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PO10114292 | Other | NY | BLUE CHOICE & MONROE PLAN |
| 000927672001 | Other | NY | HEALTH NOW |
| 7264573 | Other | NY | AETNA |
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 |
|---|---|---|---|
| 014292-1 | NY | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159315200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1317081600000",
"number": "1174614077",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "16 EDENDERY CIR",
"city": "FAIRPORT",
"state": "NY",
"postal_code": "144501013",
"telephone_number": "585-737-8545"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "16 EDENDERY CIR",
"city": "FAIRPORT",
"state": "NY",
"postal_code": "144501013",
"telephone_number": "585-737-8545"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOFFITT",
"first_name": "ANN",
"middle_name": "M",
"name_suffix": "I",
"credential": "CCC-SLP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-09-27",
"last_updated": "2011-09-27",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "NY",
"license": "014292-1",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CHOICE & MONROE PLAN",
"identifier": "PO10114292",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTH NOW",
"identifier": "000927672001",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "7264573",
"state": "NY"
}
],
"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 Sep 27, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.