Mary Pellerin Pyfrom, M.A.,CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

SA13673 Issued in FL

Practice address

4202 E Fowler Ave
Pcd1017
Tampa, FL 33620-6750

Phone

(813) 974-9844

NPI assigned

Jun 9, 2010

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Mary Grace Pellerin Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts

State licenses

Practice roles

Networks

• Freedom Health HMO Network

Interoperability endpoints

• Direct secure messaging: mpyfrom107654@direct.tgh.org
• FHIR API: https://epicproxy.et0761.epichosted.com/FHIRProxy/api/FHIR/R4/

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Tampa General Hospital

  • General Acute Care Hospital
  • Tampa, FL
  • NPI 1124558929
  NPD

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

{
    "created_epoch": "1276041600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1449792000000",
    "number": "1629398995",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 917770",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328917770"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4202 E FOWLER AVE",
            "address_2": "PCD1017",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336206750",
            "telephone_number": "813-974-9844"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PYFROM",
        "first_name": "MARY",
        "middle_name": "PELLERIN",
        "credential": "M.A.,CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-06-09",
        "last_updated": "2015-12-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "LA",
            "license": "6276",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "FL",
            "license": "SA13673",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "015807300",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "S01CE",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARY",
            "last_name": "PELLERIN",
            "middle_name": "GRACE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Christine Putt
• Amanda Puustinen, DMD
• PVCP LLC
• Vanessa L Pydeski, LCSW
• Monique Pydych
• Stanley Pyfrom, PTA
• Keieyes Tina Pyke, APRN, FNP-BC
• Heather Ann Pyle, PSY.D.
• Morgan Lynn Pyne
• Priscilla M Pyne, PA-C

• Speech-Language Pathologist in Tampa, FL
• Providers in Tampa, FL by specialty
• Speech-Language Pathologist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2015; 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.