Sandra Custodio, CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

113901 Issued in TX

Practice address

3020 Poteet Dr
Mesquite, TX 75150-4762

Phone

(972) 882-7233

NPI assigned

Nov 19, 2021

Last updated

Nov 19, 2021By the provider in NPPES

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

Electronic endpoints 1

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": "1637280000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1637280000000",
    "number": "1366109761",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "804 CAUBLE DR",
            "city": "FATE",
            "state": "TX",
            "postal_code": "750876779",
            "telephone_number": "214-287-5184"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3020 POTEET DR",
            "city": "MESQUITE",
            "state": "TX",
            "postal_code": "751504762",
            "telephone_number": "972-882-7233"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CUSTODIO",
        "first_name": "SANDRA",
        "credential": "CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-11-19",
        "last_updated": "2021-11-19",
        "certification_date": "2021-11-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "TX",
            "license": "113901",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "MSB",
            "affiliation": "N",
            "endpointDescription": "Speech therapy",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "3020 Poteet Dr",
            "city": "Mesquite",
            "state": "TX",
            "country_code": "US",
            "postal_code": "751504762",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Speech-Language Pathologist in Mesquite, TX
• Providers in Mesquite, TX by specialty
• Speech-Language Pathologist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2021; 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.