Mary Anne Dutra, M.A.,CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

SA8174 Issued in FL

Practice address

2848 Conch Hollow Dr
Brandon, FL 33511-7349

Phone

(813) 731-2363

Fax

(813) 383-4548

NPI assigned

Sep 19, 2016

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

Credentials

Master of Arts

State licenses

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

{
    "created_epoch": "1474243200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1474243200000",
    "number": "1285182253",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2848 CONCH HOLLOW DR",
            "city": "BRANDON",
            "state": "FL",
            "postal_code": "335117349",
            "telephone_number": "813-731-2363",
            "fax_number": "813-383-4548"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2848 CONCH HOLLOW DR",
            "city": "BRANDON",
            "state": "FL",
            "postal_code": "335117349",
            "telephone_number": "813-731-2363",
            "fax_number": "813-383-4548"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DUTRA",
        "first_name": "MARY",
        "middle_name": "ANNE",
        "credential": "M.A.,CCC-SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-09-19",
        "last_updated": "2016-09-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "FL",
            "license": "SA8174",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Angela Kim Dupke, BCBA
• Benjamin Madden Duplaga, MD
• Benjamin Duppstadt, DO
• Emily Dusold, RBT
• Holly Dust
• Dva Healthcare Renal Care Inc (Brandon East Dialysis)
• Dwic of Tampa Bay, Inc. (MedExpress Urgent Care - Brandon)
• Ariana Monique Dyer, DPT
• Tanquer Dyer
• Shantika Dykes, LMHC

• Speech-Language Pathologist in Brandon, FL
• Providers in Brandon, 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 19, 2016; 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.