Kashala Smith-Tavaris, MS CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

003820 Issued in CT

Practice address

60 Katona Dr Ste 24
Fairfield, CT 06824-3544

Phone

(203) 576-0142

Fax

(866) 608-3856

NPI assigned

Feb 2, 2020

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

Other identifiers 1

Other names 1

• Kashala Smith Professional name

Medicare fee-for-service enrollment

Enrolled in CT

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

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

• Yale University

  dba Yale Medicine

  • Anesthesiology Physician
  • New Haven, CT
  • NPI 1205822236

  Single Specialty

  Medicare reassignment NPD
• Yale University

  • Durable Medical Equipment & Medical Supplies
  • Fairfield, CT
  • NPI 1548066962
  NPD

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

{
    "created_epoch": "1580601600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1598486400000",
    "number": "1225669856",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "60 KATONA DR STE 24",
            "city": "FAIRFIELD",
            "state": "CT",
            "postal_code": "068243544",
            "telephone_number": "203-567-0142",
            "fax_number": "866-608-3856"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "60 KATONA DR STE 24",
            "city": "FAIRFIELD",
            "state": "CT",
            "postal_code": "068243544",
            "telephone_number": "203-576-0142",
            "fax_number": "866-608-3856"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH-TAVARIS",
        "first_name": "KASHALA",
        "credential": "MS CCC-SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-02-02",
        "last_updated": "2020-08-27",
        "certification_date": "2020-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Speech-Language Pathologist",
            "state": "CT",
            "license": "003820",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CT LICENSE IN SPEECH LANGUAGE PATHOLOGY",
            "identifier": "003820",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KASHALA",
            "last_name": "SMITH",
            "credential": "MS CCC-SLP",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Sleep Apnea Center of Connecticut LLC (The Sleep Apnea Center of Connecticut LLC)
• Sleep Healthcare of CT LLC
• Sleepwell Doctor
• Peter Alan Small, M.D.
• Smile Ark Pediatric Dentistry LLC
• Elizabeth Corr Anderson Smith, M.D.
• Emily Smith
• Jo Anne Nancy Smith, LCSW
• Julia G Smith, LCSW
• Kimberly Smith, D.C.

• Speech-Language Pathologist in Fairfield, CT
• Providers in Fairfield, CT by specialty
• Speech-Language Pathologist in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2020; 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.