Derrick Raynard Davis Jr., M.S. SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

SZ11426 Issued in FL

Practice address

5165 Adanson St
Orlando, FL 32804-1331

Phone

(352) 394-0212

NPI assigned

Dec 18, 2023

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

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

{
    "created_epoch": "1702857600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1702857600000",
    "number": "1679341804",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 120547",
            "city": "CLERMONT",
            "state": "FL",
            "postal_code": "347120547"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5165 ADANSON ST",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328041331",
            "telephone_number": "352-394-0212"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "DERRICK",
        "middle_name": "RAYNARD",
        "name_suffix": "Jr.",
        "credential": "M.S. SLP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-12-18",
        "last_updated": "2023-12-18",
        "certification_date": "2023-12-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "FL",
            "license": "SZ11426",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "securerecords.sanford.html",
            "affiliation": "Y",
            "affiliationName": "Central Florida Dreamplex LLC",
            "address_1": "2400 S Highway 27",
            "address_2": "Suite B201",
            "city": "Clermont",
            "state": "FL",
            "country_code": "US",
            "postal_code": "347116816",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Crystal Marie Davis, DENTAL HYGENSIT
• Danielle Hope Davis, LMHC
• David A Davis, MD
• David M Davis, DO
• Deanna Nicole Davis, M.A.
• Dona A Davis, LCSW
• Donovan Dennis Davis
• Doris Bradford Davis
• Dyonne Davis
• Elisabeth K Davis, MD

• Speech-Language Pathologist in Orlando, FL
• Providers in Orlando, 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 18, 2023; 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.