Kendra R Fustin

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

17370 Issued in FL

Practice address

3875 Yorktowne Blvd
Port Orange, FL 32129-6051

Phone

(386) 465-3378

NPI assigned

Jan 23, 2018

Sex

Female

Sole proprietor

No

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 FL

Enrollment records 1

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 and National Provider Directory roles.

• Empowerme Rehabilitation Florida, LLC

  • Multi-Specialty Clinic/Center
  • Stuart, FL
  • NPI 1184257602

  Speech-Language Pathologist

  Medicare reassignment NPD
• Empowerme Rehabilitation Florida, LLC

  • Rehabilitation Clinic/Center
  • The Villages, FL
  • NPI 1477245892
  NPD
• Rehabcare Group East, LLC

  • Rehabilitation Clinic/Center
  • Shalimar, FL
  • NPI 1407382278
  NPD (past)

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

{
    "created_epoch": "1516665600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726617600000",
    "number": "1205334463",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1996 YELLOWFIN DR",
            "city": "PORT ORANGE",
            "state": "FL",
            "postal_code": "321283016",
            "telephone_number": "210-850-2024"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3875 YORKTOWNE BLVD",
            "city": "PORT ORANGE",
            "state": "FL",
            "postal_code": "321296051",
            "telephone_number": "386-465-3378"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FUSTIN",
        "first_name": "KENDRA",
        "middle_name": "R",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-01-23",
        "last_updated": "2024-09-18",
        "certification_date": "2024-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "FL",
            "license": "17370",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Walfrido Fuentes Claro
• Stephanie Fuentes
• Courtney Fuhrman
• Anna Fukushima
• Lauren Furey
• G & C Healthcare, Inc.
• G & S Coordination LLC
• Ann Gaffka, ARNP-C
• Seneka Rachel Gainer, PHD, LPC, LMFT, NCC
• Carol M Gaines, DO

• Speech-Language Pathologist in Port Orange, FL
• Providers in Port Orange, 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 Sep 18, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.