Active NPI
Diandra Bailey, SLP
- Speech-Language Pathologist
- Indian Trail, NC
National Provider Identifier
1407279425
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 11103
- Practice address
- 3315 Faith Church Rd
Indian Trail, NC 28079-9300 - Phone
- (704) 882-3420
- NPI assigned
- Jan 27, 2014
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 11103 | NC | Primary |
| Speech-Language Pathologist | 235Z00000X | 5319 | SC |
Addresses
Primary practice location
3315 Faith Church Rd
Indian Trail, NC 28079-9300
Mailing address
5642 Via Romano Dr Apt F
Charlotte, NC 28270-6939
Phone (864) 407-2793
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5319 | SC | MD | Professional Counselor |
| 11103 | NC | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1390780800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1636502400000",
"number": "1407279425",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5642 VIA ROMANO DR APT F",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282706939",
"telephone_number": "864-407-2793"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3315 FAITH CHURCH RD",
"city": "INDIAN TRAIL",
"state": "NC",
"postal_code": "280799300",
"telephone_number": "704-882-3420"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BAILEY",
"first_name": "DIANDRA",
"credential": "SLP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-01-27",
"last_updated": "2021-11-10",
"certification_date": "2021-11-10",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "NC",
"license": "11103",
"primary": true
},
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "SC",
"license": "5319",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Indian Trail, NC
- Julie Atamansky, OTR/L
- Atrium Health Specialty Network Inc (Atrium Health Physical Therapy)
- Austin Drugs, Inc (Austin Drugs)
- Kimberly Baxter Ayres, PT
- Olabisi Badmus, M.D
- Allison Barclay, DPT
- Beam and Blizzard LLC (Indian Trail Pharmacy)
- Beam and Blizzard, LLC (Indian Trail Pharmacy)
- Sam Beegle, RPH
- Miguel A Bejarano, BS RPH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 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.