Mya Lucero Medina, CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

SA20339 Issued in FL

Practice address

40124 Highway 27 Ste 103
Davenport, FL 33837-5905

Phone

(863) 419-2500

NPI assigned

Jul 13, 2022

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)

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 and National Provider Directory roles.

• Adventhealth Polk North Inc

  • General Acute Care Hospital
  • Davenport, FL
  • NPI 1801457510
  NPD (past)
• Haines City Hma LLC

  • General Acute Care Hospital
  • Davenport, FL
  • NPI 1578518403

  Single Specialty

  NPD (past)

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

{
    "created_epoch": "1657670400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1657670400000",
    "number": "1205560422",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "120 BRAD CIR",
            "city": "WINTER HAVEN",
            "state": "FL",
            "postal_code": "338804983",
            "telephone_number": "863-604-9886"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "40124 HIGHWAY 27 STE 103",
            "city": "DAVENPORT",
            "state": "FL",
            "postal_code": "338375905",
            "telephone_number": "863-419-2500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEDINA",
        "first_name": "MYA",
        "middle_name": "LUCERO",
        "credential": "CCC-SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-07-13",
        "last_updated": "2022-07-13",
        "certification_date": "2022-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Speech-Language Pathologist",
            "state": "FL",
            "license": "SA20339",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Medical Home Alliance LLC
• Medical Home Alliance LLC
• Medical Home Alliance LLC
• Medical Home Alliance LLC
• Marko Anthony Medina, PTA
• Tanairy Medina
• Medoz Pharmacy of Polk Inc
• Medoz Pharmacy of Polk LLC
• Robyn Tracy Meers, APRN
• Andrew Dean Meikle, MD

• Speech-Language Pathologist in Davenport, FL
• Providers in Davenport, 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 Jul 13, 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.