Active NPI
Ayana Damell Ellis
- Speech-Language Pathologist
- Suffolk, VA
National Provider Identifier
1730743790
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 2202009572
- Practice address
- 100 N Main St
Suffolk, VA 23434-4529 - Phone
- (757) 925-6764
- NPI assigned
- Apr 25, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 2202009572 | VA | Primary |
Addresses
Primary practice location
100 N Main St
Suffolk, VA 23434-4529
Mailing address
100 N Main St
Suffolk, VA 23434-4529
Phone (757) 925-6764
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2204000200 | Medicaid | VA |
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
| License | State | Type | Specialty |
|---|---|---|---|
| 2202009572 | VA | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1556150400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1692748800000",
"number": "1730743790",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "100 N MAIN ST",
"city": "SUFFOLK",
"state": "VA",
"postal_code": "234344529",
"telephone_number": "757-925-6764"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 N MAIN ST",
"city": "SUFFOLK",
"state": "VA",
"postal_code": "234344529",
"telephone_number": "757-925-6764"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLIS",
"first_name": "AYANA",
"middle_name": "DAMELL",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-04-25",
"last_updated": "2023-08-23",
"certification_date": "2023-08-23",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "VA",
"license": "2202009572",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2204000200",
"state": "VA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Suffolk, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 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.