Samantha Jo Destazio

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

6550 Issued in SC

Practice address

290 N Grove Medical Park Dr
Spartanburg, SC 29303-4222

Phone

(864) 345-1700

NPI assigned

Apr 11, 2019

Sex

Female

Sole proprietor

No

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

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

{
    "created_epoch": "1554940800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1554940800000",
    "number": "1326501818",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "290 N GROVE MEDICAL PARK DR",
            "city": "SPARTANBURG",
            "state": "SC",
            "postal_code": "293034222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "290 N GROVE MEDICAL PARK DR",
            "city": "SPARTANBURG",
            "state": "SC",
            "postal_code": "293034222",
            "telephone_number": "864-345-1700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DESTAZIO",
        "first_name": "SAMANTHA",
        "middle_name": "JO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-04-11",
        "last_updated": "2019-04-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "SC",
            "license": "6550",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Wayne Holt Denton, MD
• Department of Health Environmental Control
• Roger Depra, M.D.
• Mit Desai, M.D.
• Rowena Emilia Desailly-Chanson, MD
• Mitchell L Devlin, DO
• Devore Dermatology PA
• Karen A Devore, MD
• Velda L Deyoung, CAC II
• Lauren Dhans

• Speech-Language Pathologist in Spartanburg, SC
• Providers in Spartanburg, SC by specialty
• Speech-Language Pathologist in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2019; 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.