Individual provider Active NPI

Michelle Tanya Haynes, MS CCC SLP

  • Speech-Language Pathologist
  • St Petersburg, FL
National Provider Identifier
1679789432
Registry record updated Jul 7, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
SA8088 Issued in FL
Practice address
6734 31St Way South
St. Petersburg, FL 33712-5406
Phone
(727) 776-5534
Fax
(727) 546-8527
NPI assigned
May 15, 2007
Last updated
Jul 7, 2011By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 7, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X SA8088 FL Primary

Addresses

Primary practice location

6734 31St Way South
St. Petersburg, FL 33712-5406

Mailing address

6734 31St Way South
St. Petersburg, FL 33712-5406
Phone (727) 776-5534

Other identifiers 1

IdentifierTypeStateIssuer
891090100MedicaidFL

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)
Enrolled
Credentials
Master of Science

NPI Registry JSON

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

{
    "created_epoch": "1179187200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1309996800000",
    "number": "1679789432",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6734 31ST WAY SOUTH",
            "city": "ST. PETERSBURG",
            "state": "FL",
            "postal_code": "337125406",
            "telephone_number": "727-776-5534",
            "fax_number": "727-546-8527"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6734 31ST WAY SOUTH",
            "city": "ST. PETERSBURG",
            "state": "FL",
            "postal_code": "337125406",
            "telephone_number": "727-776-5534",
            "fax_number": "727-546-8527"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAYNES",
        "first_name": "MICHELLE",
        "middle_name": "TANYA",
        "name_prefix": "Ms.",
        "credential": "MS CCC SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-05-15",
        "last_updated": "2011-07-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "FL",
            "license": "SA8088",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "891090100",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in St Petersburg, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 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.

Verify at the official NPI Registry.