Individual provider Active NPI

Joshua Theodore Moran

  • Speech-Language Assistant
  • Sanford, FL
National Provider Identifier
1669064499
Registry record updated Feb 3, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language AssistantTaxonomy code 2355S0801X
License
4700 Issued in FL
Practice address
111 E Lake Mary Blvd Ste 3
Sanford, FL 32773-7111
Phone
(417) 203-9492
NPI assigned
Feb 3, 2021
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 3, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 2355S0801X 4700 FL Primary

Addresses

Primary practice location

111 E Lake Mary Blvd Ste 3
Sanford, FL 32773-7111

Mailing address

12084 Lake Cypress Cir Apt 308
Orlando, FL 32828-7057
Phone (561) 706-8908

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

LicenseStateTypeSpecialty
4700FLMDSpeech-Language Assistant

NPI Registry JSON

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

{
    "created_epoch": "1612310400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1612310400000",
    "number": "1669064499",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12084 LAKE CYPRESS CIR APT 308",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328287057",
            "telephone_number": "561-706-8908"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 E LAKE MARY BLVD STE 3",
            "city": "SANFORD",
            "state": "FL",
            "postal_code": "327737111",
            "telephone_number": "417-203-9492"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MORAN",
        "first_name": "JOSHUA",
        "middle_name": "THEODORE",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-02-03",
        "last_updated": "2021-02-03",
        "certification_date": "2021-02-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2355S0801X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist/Technologist, Speech-Language Assistant",
            "state": "FL",
            "license": "4700",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sanford, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2021; 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.