NPIMap

Organization Active NPI

Fiesta Pediatric Therapy

  • Speech-Language Pathologist
  • Mesa, AZ
National Provider Identifier
1508931569
Registry record updated Sep 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
Legal business name
FIESTA PEDIATRIC THERAPY
Practice address
930 W Southern Ave
Suite 10
Mesa, AZ 85210-4938
Phone
(480) 835-0857
Fax
(480) 898-0138
NPI assigned
Nov 22, 2006
Last updated
Sep 11, 2025By the provider in NPPES
Organization subpart
No

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

Authorized official

Name
Mrs. Mary Ann SheelyNPI 1003946005
Title
Owner
Phone
(602) 265-4124

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 2251P0200X
Pediatric Occupational TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225XP0200X
Speech-Language PathologistGroup: 193200000X MULTI-SPECIALTY GROUP 235Z00000X Primary

Addresses

Primary practice location

930 W Southern Ave
Suite 10
Mesa, AZ 85210-4938

Mailing address

1641 E Osborn Rd
Suite 1
Phoenix, AZ 85016-7146
Phone (602) 265-4124

National Provider Directory

National Provider Directory
Tax ID family
Fiesta Pediatric Therapy2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

930 W Southern Ave
Ste 10
Mesa, AZ 85210
Phone (480) 835-0857

1641 E Osborn Rd
Ste 1
Phoenix, AZ 85016
Phone (602) 264-0097

Practitioners & affiliated clinicians

Practitioners 23

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1164153600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757548800000",
    "number": "1508931569",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1641 E OSBORN RD",
            "address_2": "SUITE 1",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850167146",
            "telephone_number": "602-265-4124",
            "fax_number": "602-248-8843"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "930 W SOUTHERN AVE",
            "address_2": "SUITE 10",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852104938",
            "telephone_number": "480-835-0857",
            "fax_number": "480-898-0138"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FIESTA PEDIATRIC THERAPY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-22",
        "last_updated": "2025-09-11",
        "status": "A",
        "authorized_official_last_name": "SHEELY",
        "authorized_official_first_name": "MARY ANN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "602-265-4124",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "2251P0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist, Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225XP0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist, Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mesa, AZ

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.