Individual provider Active NPI

Melissa Moore Fastiggi, CCC-SLP

  • Speech-Language Pathologist
  • Atlanta, GA
National Provider Identifier
1689767402
Registry record updated Mar 24, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
SLP006337 Issued in GA
Practice address
1605 Calibre Woods Dr NE
Atlanta, GA 30329-3954
Phone
(706) 340-1704
NPI assigned
Oct 2, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 24, 2016

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 SLP006337 GA Primary

Addresses

Primary practice location

1605 Calibre Woods Dr NE
Atlanta, GA 30329-3954

Mailing address

1605 Calibre Woods Dr NE
Atlanta, GA 30329-3954
Phone (706) 340-1704

Other identifiers 1

IdentifierTypeStateIssuer
323213827AMedicaidGA

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
SLP006337GAMDSpeech-Language Pathologist

NPI Registry JSON

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

{
    "created_epoch": "1159747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1458777600000",
    "number": "1689767402",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1605 CALIBRE WOODS DR NE",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303293954",
            "telephone_number": "706-340-1704"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1605 CALIBRE WOODS DR NE",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303293954",
            "telephone_number": "706-340-1704"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FASTIGGI",
        "first_name": "MELISSA",
        "middle_name": "MOORE",
        "name_prefix": "Mrs.",
        "credential": "CCC-SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-10-02",
        "last_updated": "2016-03-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "GA",
            "license": "SLP006337",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "323213827A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Atlanta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2016; 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.