Sunshine State Speech-Language Pathology LLC

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

Legal business name

SUNSHINE STATE SPEECH-LANGUAGE PATHOLOGY LLC

Practice address

79 Sherry Dr
Atlantic Beach, FL 32233-5233

Phone

(904) 386-1012

NPI assigned

Aug 1, 2022

Organization subpart

No

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

Authorized official

Name

Mrs. Abby Ross-Kennedy, CCC-SLP

Title

Speech-Language Pathologist

Phone

(904) 386-1012

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1659312000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1662595200000",
    "number": "1760119705",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "79 SHERRY DR",
            "city": "ATLANTIC BEACH",
            "state": "FL",
            "postal_code": "322335233",
            "telephone_number": "904-386-1012"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "79 SHERRY DR",
            "city": "ATLANTIC BEACH",
            "state": "FL",
            "postal_code": "322335233",
            "telephone_number": "904-386-1012"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUNSHINE STATE SPEECH-LANGUAGE PATHOLOGY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-08-01",
        "last_updated": "2022-09-08",
        "certification_date": "2022-09-08",
        "status": "A",
        "authorized_official_last_name": "ROSS-KENNEDY",
        "authorized_official_first_name": "ABBY",
        "authorized_official_title_or_position": "SPEECH-LANGUAGE PATHOLOGIST",
        "authorized_official_telephone_number": "904-386-1012",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "CCC-SLP"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "115056600",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Speech-Language Pathologist in Atlantic Beach, FL
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2022; 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.