Shannon Marie Tyler

Primary specialty

Speech-Language AssistantTaxonomy code 2355S0801X

License

SAS1421 Issued in ME

Practice address

28 N Heritage Woods LN
Winthrop, ME 04364-3240

Phone

(207) 377-2472

Fax

(207) 377-2472

NPI assigned

Dec 22, 2009

Last updated

Dec 22, 2009By the provider in NPPES

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

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

• Lynda J. Mazzola S-L Pathologist PC

  • Speech-Language Pathologist
  • Winthrop, ME
  • NPI 1457483463
  NPD (past)

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

{
    "created_epoch": "1261440000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1261440000000",
    "number": "1285963298",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "69 CONY RD",
            "city": "AUGUSTA",
            "state": "ME",
            "postal_code": "043300500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "28 N HERITAGE WOODS LN",
            "city": "WINTHROP",
            "state": "ME",
            "postal_code": "043643240",
            "telephone_number": "207-377-2472",
            "fax_number": "207-377-2472"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TYLER",
        "first_name": "SHANNON",
        "middle_name": "MARIE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-12-22",
        "last_updated": "2009-12-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2355S0801X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Speech-Language Assistant",
            "state": "ME",
            "license": "SAS1421",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "266450099",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mary Sturtevant, SL
• Town of Winthrop (Winthrop Public Schools)
• Town of Winthrop (Town of Winthrop Ambulance)
• Tranquility Group Inc
• Kaitlyn Marie Turmelle, DC
• Walgreen Eastern Co Inc (Walgreens #17745)
• Lara M Walsh, MD
• Westwind House
• Winthrop Manor Long Term Care & Rehab Center, Inc.
• Winthrop Public Schools Aos 97

• Speech-Language Assistant in Winthrop, ME
• Providers in Winthrop, ME by specialty
• Speech-Language Assistant in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2009; 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.