Patrick Dermico Elliott, SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

14999 Issued in NC

Practice address

934 Cambridge St
Fayetteville, NC 28303-5300

Phone

(910) 493-3520

Fax

(910) 493-3520

NPI assigned

Oct 10, 2022

Sex

Male

Sole proprietor

No

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

Enrolled in NC

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1665360000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1665360000000",
    "number": "1710602933",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "920 CAMBRIDGE ST",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283035300",
            "telephone_number": "910-493-3555",
            "fax_number": "910-493-3520"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "934 CAMBRIDGE ST",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283035300",
            "telephone_number": "910-493-3520",
            "fax_number": "910-493-3520"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIOTT",
        "first_name": "PATRICK",
        "middle_name": "DERMICO",
        "credential": "SLP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-10-10",
        "last_updated": "2022-10-10",
        "certification_date": "2022-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NC",
            "license": "14999",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "admin@fayettevillenewleaf.com",
            "affiliation": "N",
            "endpointDescription": "Group email address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "934 Cambridge St",
            "city": "Fayetteville",
            "state": "NC",
            "country_code": "US",
            "postal_code": "283035300",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Curtis Elliott Sr., LPTA
• Deidre A Elliott
• Kenyatta Elliott, IBCLC
• Marquita Elliott, COUNSELOR
• Molly Elliott, DMD
• Teresa Elliott
• William Joseph Elliott III, PHARM.D., BCPS
• Ellis Counseling Services PLLC
• Allison Ellis, DO
• Desiree Anastashia Ellis

• Speech-Language Pathologist in Fayetteville, NC
• Providers in Fayetteville, NC by specialty
• Speech-Language Pathologist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.