Active NPI
Melissa Serrano
- Speech-Language Pathologist
- Port Saint Lucie, FL
National Provider Identifier
1770860850
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- SA15302
- Practice address
- 467 NW Prima Vista Blvd
Port Saint Lucie, FL 34983-8731 - Phone
- (772) 249-0341
- Fax
- (772) 249-4642
- NPI assigned
- Nov 3, 2011
- 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 | SA15302 | FL | Primary |
Addresses
Primary practice location
467 NW Prima Vista Blvd
Port Saint Lucie, FL 34983-8731
Mailing address
6136 NW Kendra LN
Port Saint Lucie, FL 34983-4139
Phone (787) 412-4002
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770860850 | Medicaid | FL |
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 |
|---|---|---|---|
| SA15302 | FL | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1320278400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1543449600000",
"number": "1770860850",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6136 NW KENDRA LN",
"city": "PORT SAINT LUCIE",
"state": "FL",
"postal_code": "349834139",
"telephone_number": "787-412-4002"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "467 NW PRIMA VISTA BLVD",
"city": "PORT SAINT LUCIE",
"state": "FL",
"postal_code": "349838731",
"telephone_number": "772-249-0341",
"fax_number": "772-249-4642"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SERRANO",
"first_name": "MELISSA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-11-03",
"last_updated": "2018-11-29",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "FL",
"license": "SA15302",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1770860850",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Port Saint Lucie, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.