Individual provider Active NPI

Mary Ellen Deloache, M.ED.

  • Developmental Therapist
  • St Petersburg, FL
National Provider Identifier
1457404980
Registry record updated Sep 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Developmental TherapistTaxonomy code 222Q00000X
Practice address
801 6TH St S
Dept 7470
St Petersburg, FL 33701-4816
Phone
(727) 767-6726
Fax
(727) 767-4715
NPI assigned
Jan 19, 2007
Last updated
Sep 11, 2025By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 11, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X
Developmental Therapist 222Q00000X Primary

Addresses

Primary practice location

801 6TH St S
Dept 7470
St Petersburg, FL 33701-4816

Mailing address

4623 Alisa Cir NE
St Petersburg, FL 33703-4371
Phone (727) 526-5519

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 Education

NPI Registry JSON

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

{
    "created_epoch": "1169164800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757548800000",
    "number": "1457404980",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4623 ALISA CIR NE",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337034371",
            "telephone_number": "727-526-5519",
            "fax_number": "727-526-5519"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 6TH ST S",
            "address_2": "DEPT 7470",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337014816",
            "telephone_number": "727-767-6726",
            "fax_number": "727-767-4715"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DELOACHE",
        "first_name": "MARY ELLEN",
        "name_prefix": "Ms.",
        "credential": "M.ED.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-01-19",
        "last_updated": "2025-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "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": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in St Petersburg, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; 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.