Active NPI
Elli Emmanuel, M.A. C.C.C. /S.L.P
- Speech-Language Pathologist
- Fort Myers, FL
National Provider Identifier
1316043235
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- SA1179
- Practice address
- 1440 Park Shore Cir
#1
Fort Myers, FL 33901-9614 - Phone
- (239) 826-3593
- NPI assigned
- Sep 16, 2006
- 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | SA1179 | FL | Primary |
| Social Worker | 104100000X | |||
| Developmental Therapist | 222Q00000X |
Addresses
Primary practice location
1440 Park Shore Cir
#1
Fort Myers, FL 33901-9614
Mailing address
1440 Park Shore Cir
#1
Fort Myers, FL 33901-9614
Phone (239) 826-3593
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 001505300 | Medicaid | FL | |
| 812311000 | Medicaid | FL | |
| 880500800 | 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
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SA1179 | FL | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158364800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1487548800000",
"number": "1316043235",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1440 PARK SHORE CIR",
"address_2": "#1",
"city": "FORT MYERS",
"state": "FL",
"postal_code": "339019614",
"telephone_number": "239-826-3593"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1440 PARK SHORE CIR",
"address_2": "#1",
"city": "FORT MYERS",
"state": "FL",
"postal_code": "339019614",
"telephone_number": "239-826-3593"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EMMANUEL",
"first_name": "ELLI",
"name_prefix": "Ms.",
"credential": "M.A. C.C.C. /S.L.P",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-09-16",
"last_updated": "2017-02-20",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "FL",
"license": "SA1179",
"primary": true
},
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": null,
"license": null,
"primary": false
},
{
"code": "222Q00000X",
"taxonomy_group": "",
"desc": "Developmental Therapist",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "001505300",
"state": "FL"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "812311000",
"state": "FL"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "880500800",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fort Myers, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.