Active NPI
Shelonda A Porter, M.ED., CCC-SLP
- Speech-Language Pathologist
- Waycross, GA
National Provider Identifier
1356414726
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- SLP005147
- Practice address
- 3085 Bentwood Dr
Waycross, GA 31503-4117 - Phone
- (912) 288-0214
- Fax
- (912) 283-1570
- NPI assigned
- Nov 15, 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | SLP005147 | GA | Primary |
Addresses
Primary practice location
3085 Bentwood Dr
Waycross, GA 31503-4117
Mailing address
3085 Bentwood Dr
Waycross, GA 31503-4117
Phone (912) 288-0214
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 12039364 | Other | ASHA CERTIFICATION | |
| 1364319 | Other | GA | GSHA MEMBERSHIP |
| 10034561 | Medicaid | GA | |
| 305511 | Medicaid | GA | |
| SLP005147 | Other | GA | GA LICENSE |
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)
- Enrolled
- Credentials
- Master of Education
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SLP005147 | GA | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163548800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1356414726",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3085 BENTWOOD DR",
"city": "WAYCROSS",
"state": "GA",
"postal_code": "315034117",
"telephone_number": "912-288-0214",
"fax_number": "912-283-1570"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3085 BENTWOOD DR",
"city": "WAYCROSS",
"state": "GA",
"postal_code": "315034117",
"telephone_number": "912-288-0214",
"fax_number": "912-283-1570"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PORTER",
"first_name": "SHELONDA",
"middle_name": "A",
"name_prefix": "Mrs.",
"credential": "M.ED., CCC-SLP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-11-15",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "GA",
"license": "SLP005147",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ASHA CERTIFICATION",
"identifier": "12039364",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GSHA MEMBERSHIP",
"identifier": "1364319",
"state": "GA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "10034561",
"state": "GA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "305511",
"state": "GA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GA LICENSE",
"identifier": "SLP005147",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Waycross, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.