Active NPI
Sufia Shaista Nisar, M.SC., CCC-SLP
- Speech-Language Pathologist
- Pepper Pike, OH
National Provider Identifier
1619251774
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- SP-10166
- Practice address
- 6475 Park Pointe CT
Pepper Pike, OH 44124-5395 - Phone
- (732) 476-4334
- NPI assigned
- Oct 6, 2011
- 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 | SP-10166 | OH | Primary |
Addresses
Primary practice location
6475 Park Pointe CT
Pepper Pike, OH 44124-5395
Mailing address
6475 Park Pointe CT
Pepper Pike, OH 44124-5395
Phone (732) 476-4334
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1564187 | Medicaid | OH |
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 |
|---|---|---|---|
| SP-10166 | OH | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1317859200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1415059200000",
"number": "1619251774",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6475 PARK POINTE CT",
"city": "PEPPER PIKE",
"state": "OH",
"postal_code": "441245395",
"telephone_number": "732-476-4334"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6475 PARK POINTE CT",
"city": "PEPPER PIKE",
"state": "OH",
"postal_code": "441245395",
"telephone_number": "732-476-4334"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NISAR",
"first_name": "SUFIA",
"middle_name": "SHAISTA",
"name_prefix": "Mrs.",
"credential": "M.SC., CCC-SLP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-10-06",
"last_updated": "2014-11-04",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "OH",
"license": "SP-10166",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1564187",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Pepper Pike, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.