Active NPI
Shabronah Pettiford
- Speech-Language Assistant
- Fort Pierce, FL
National Provider Identifier
1780477489
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Assistant
- License
- 4746
- Practice address
- 5775 Deer Run Dr
Fort Pierce, FL 34951-3343 - Phone
- (610) 564-1508
- NPI assigned
- May 26, 2025
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Assistant | 2355S0801X | 9305 | CA | |
| Speech-Language Assistant | 2355S0801X | 4746 | FL | Primary |
Addresses
Primary practice location
5775 Deer Run Dr
Fort Pierce, FL 34951-3343
Mailing address
5775 Deer Run Dr
Fort Pierce, FL 34951-3343
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 |
|---|---|---|---|
| 4746 | FL | MD | Speech-Language Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1748217600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1748217600000",
"number": "1780477489",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5775 DEER RUN DR",
"city": "FORT PIERCE",
"state": "FL",
"postal_code": "349513343"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5775 DEER RUN DR",
"city": "FORT PIERCE",
"state": "FL",
"postal_code": "349513343",
"telephone_number": "610-564-1508"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETTIFORD",
"first_name": "SHABRONAH",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2025-05-26",
"last_updated": "2025-05-26",
"certification_date": "2025-05-26",
"status": "A"
},
"taxonomies": [
{
"code": "2355S0801X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Speech-Language Assistant",
"state": "CA",
"license": "9305",
"primary": false
},
{
"code": "2355S0801X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Speech-Language Assistant",
"state": "FL",
"license": "4746",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Pierce, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.