Individual provider Active NPI

Nicole Shaffer

  • Speech-Language Pathologist
  • Tampa, FL
National Provider Identifier
1194128488
Registry record updated Oct 1, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
SZ 6903 Issued in FL
Practice address
6508 Gunn Hwy
Tampa, FL 33625-4022
Phone
(813) 963-6923
Fax
(813) 264-0768
NPI assigned
Oct 1, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 1, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X SZ 6903 FL Primary

Addresses

Primary practice location

6508 Gunn Hwy
Tampa, FL 33625-4022

Mailing address

6508 Gunn Hwy
Tampa, FL 33625-4022
Phone (813) 963-6923

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

LicenseStateTypeSpecialty
SZ 6903FLMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Independent Living Inc. PastSince Nov 26, 2023 Accepting new patients
Independent Living Inc. Speech-Language Pathologist Past Accepting new patients

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1412121600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1412121600000",
    "number": "1194128488",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6508 GUNN HWY",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336254022",
            "telephone_number": "813-963-6923",
            "fax_number": "813-264-0768"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6508 GUNN HWY",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336254022",
            "telephone_number": "813-963-6923",
            "fax_number": "813-264-0768"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAFFER",
        "first_name": "NICOLE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-10-01",
        "last_updated": "2014-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "FL",
            "license": "SZ 6903",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tampa, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2014; 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.