Active NPI
Randi Paige Revels, M.S., CCC-SLP
- Speech-Language Pathologist
- San Mateo, FL
National Provider Identifier
1255026423
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- SA14886
- Practice address
- 130 Tupelo Dr
San Mateo, FL 32187-2468 - Phone
- (386) 916-8900
- NPI assigned
- Apr 5, 2023
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | SA14886 | FL | Primary |
Addresses
Primary practice location
130 Tupelo Dr
San Mateo, FL 32187-2468
Mailing address
130 Tupelo Dr
San Mateo, FL 32187-2468
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
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SA14886 | FL | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| D & K Therapy LLC | Multi-Specialty | Current | Accepting new patients |
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1680652800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1680652800000",
"number": "1255026423",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "130 TUPELO DR",
"city": "SAN MATEO",
"state": "FL",
"postal_code": "321872468"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "130 TUPELO DR",
"city": "SAN MATEO",
"state": "FL",
"postal_code": "321872468",
"telephone_number": "386-916-8900"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REVELS",
"first_name": "RANDI",
"middle_name": "PAIGE",
"name_prefix": "Mrs.",
"credential": "M.S., CCC-SLP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2023-04-05",
"last_updated": "2023-04-05",
"certification_date": "2023-04-05",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Speech-Language Pathologist",
"state": "FL",
"license": "SA14886",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Mateo, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.