Active NPI
Breanna Wallace
- Speech-Language Pathologist
- Forest Hills, NY
National Provider Identifier
1538575873
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 025278
- Practice address
- 9130 Metropolitan Ave
Forest Hills, NY 11375-6671 - Phone
- (718) 286-4700
- NPI assigned
- Jul 8, 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 025278 | NY | Primary |
Addresses
Primary practice location
9130 Metropolitan Ave
Forest Hills, NY 11375-6671
Mailing address
9130 Metropolitan Ave
Forest Hills, NY 11375-6671
Phone (718) 286-4700
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 025278 | NY | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1404777600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1481500800000",
"number": "1538575873",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9130 METROPOLITAN AVE",
"city": "FOREST HILLS",
"state": "NY",
"postal_code": "113756671",
"telephone_number": "718-286-4700"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9130 METROPOLITAN AVE",
"city": "FOREST HILLS",
"state": "NY",
"postal_code": "113756671",
"telephone_number": "718-286-4700"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLACE",
"first_name": "BREANNA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-07-08",
"last_updated": "2016-12-12",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "NY",
"license": "025278",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Forest Hills, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.