Active NPI
Jessica S. Cordero
- Behavior Technician
- Port Charlotte, FL
National Provider Identifier
1215439633
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- Practice address
- 22655 Bayshore Rd
Port Charlotte, FL 33980-2018 - Phone
- (239) 351-4787
- NPI assigned
- Mar 1, 2018
- 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Developmental Therapist | 222Q00000X | |||
| Speech-Language Assistant | 2355S0801X | SI-4635 | FL | |
| Behavior Technician | 106S00000X | Primary |
Addresses
Primary practice location
22655 Bayshore Rd
Port Charlotte, FL 33980-2018
Mailing address
3525 6TH Ave NE
Naples, FL 34120-4914
Phone (954) 298-7207
Other practice location 1
1121 Druid Rd E Apt 812
Clearwater, FL 33756-4060
Phone (954) 298-7207
Other practice location 2
550 N Reo St
Tampa, FL 33609-1061
Phone (813) 374-2070
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 222 | Medicaid | FL |
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 |
|---|---|---|---|
| SI-4635 | FL | MD | Speech-Language Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1519862400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1707696000000",
"number": "1215439633",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3525 6TH AVE NE",
"city": "NAPLES",
"state": "FL",
"postal_code": "341204914",
"telephone_number": "954-298-7207"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "22655 BAYSHORE RD",
"city": "PORT CHARLOTTE",
"state": "FL",
"postal_code": "339802018",
"telephone_number": "239-351-4787"
}
],
"practiceLocations": [
{
"address_1": "1121 Druid Rd E Apt 812",
"address_purpose": "LOCATION",
"city": "Clearwater",
"state": "FL",
"postal_code": "337564060",
"country_code": "US",
"telephone_number": "954-298-7207",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "550 N Reo St",
"address_purpose": "LOCATION",
"city": "Tampa",
"state": "FL",
"postal_code": "336091061",
"country_code": "US",
"telephone_number": "813-374-2070",
"fax_number": "813-337-0937",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "CORDERO",
"first_name": "JESSICA",
"middle_name": "S.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-03-01",
"last_updated": "2024-02-12",
"certification_date": "2024-02-12",
"status": "A"
},
"taxonomies": [
{
"code": "222Q00000X",
"taxonomy_group": "",
"desc": "Developmental Therapist",
"state": null,
"license": null,
"primary": false
},
{
"code": "2355S0801X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Speech-Language Assistant",
"state": "FL",
"license": "SI-4635",
"primary": false
},
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "222",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Port Charlotte, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.