Andrea Russell

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

SA16793 Issued in FL

Practice address

12901 Broleman Rd
Orlando, FL 32832-6107

Phone

(407) 641-0808

Fax

(407) 812-4358

NPI assigned

Dec 10, 2013

Last updated

Apr 5, 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 3

Addresses

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Florida Pediatric Therapy, LLC

  • Developmental Therapist
  • Orlando, FL
  • NPI 1457007742
  NPD
• Florida Pediatric Therapy, LLC

  • Clinic/Center
  • Orlando, FL
  • NPI 1043483969

  Developmental Therapist

  NPD (past)

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

{
    "created_epoch": "1386633600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649116800000",
    "number": "1205267762",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "921 GLENDORA RD S",
            "city": "KISSIMMEE",
            "state": "FL",
            "postal_code": "347593653",
            "telephone_number": "717-226-6403"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12901 BROLEMAN RD",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328326107",
            "telephone_number": "407-641-0808",
            "fax_number": "407-812-4358"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "921 Glendora Rd S",
            "address_purpose": "LOCATION",
            "city": "Kissimmee",
            "state": "FL",
            "postal_code": "347593653",
            "country_code": "US",
            "telephone_number": "717-226-6403",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "ANDREA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-12-10",
        "last_updated": "2022-04-05",
        "certification_date": "2022-04-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "PA",
            "license": "SL007674",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "FL",
            "license": "SA16793",
            "primary": true
        },
        {
            "code": "222Q00000X",
            "taxonomy_group": "",
            "desc": "Developmental Therapist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rushin Patel MD LLC
• Ann Rushin
• Tajuana Denise Rushin, MA, MRT, CART, CLST
• Carlee Rushlow, MD
• Alisha Russell
• Christopher M Russell, MD
• Deonia Russell, MSW
• Kearstin K. Russell, APRN
• Laura Russell, LCSW
• Michael L Russell, M.D.

• Speech-Language Pathologist in Orlando, FL
• Providers in Orlando, 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 5, 2022; 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.