Active NPI
Misti Golden
- Speech-Language Pathologist
- Brandon, FL
National Provider Identifier
1649433905
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- SA7830
- Practice address
- 602 Vonderburg Dr
Suite 201
Brandon, FL 33511-5900 - Phone
- (813) 653-1149
- Fax
- (813) 654-6644
- NPI assigned
- Jul 8, 2008
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | SA7830 | FL | Primary |
| Developmental Therapist | 222Q00000X |
Addresses
Primary practice location
602 Vonderburg Dr
Suite 201
Brandon, FL 33511-5900
Mailing address
602 Vonderburg Dr
Suite 201
Brandon, FL 33511-5900
Phone (813) 653-1149
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000252300 | Medicaid | FL | |
| 001867500 | Medicaid | FL |
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 |
|---|---|---|---|
| SA7830 | FL | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1215475200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1296691200000",
"number": "1649433905",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "602 VONDERBURG DR",
"address_2": "SUITE 201",
"city": "BRANDON",
"state": "FL",
"postal_code": "335115900",
"telephone_number": "813-653-1149",
"fax_number": "813-654-6644"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "602 VONDERBURG DR",
"address_2": "SUITE 201",
"city": "BRANDON",
"state": "FL",
"postal_code": "335115900",
"telephone_number": "813-653-1149",
"fax_number": "813-654-6644"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOLDEN",
"first_name": "MISTI",
"name_prefix": "Mrs.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-07-08",
"last_updated": "2011-02-03",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "FL",
"license": "SA7830",
"primary": true
},
{
"code": "222Q00000X",
"taxonomy_group": "",
"desc": "Developmental Therapist",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "000252300",
"state": "FL"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "001867500",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Brandon, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.