Active NPI
Dylan Moore
- Speech-Language Pathologist
- Brandon, MS
National Provider Identifier
1831012590
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- S-5495
- Practice address
- 390 Audubon Cir
Brandon, MS 39047-7778 - Phone
- (662) 571-0711
- NPI assigned
- Jul 31, 2026
- Last updated
- Jul 31, 2026
- Sex
- Male
- 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 | S-5495 | MS | Primary |
Addresses
Primary practice location
390 Audubon Cir
Brandon, MS 39047-7778
Mailing address
390 Audubon Cir
Brandon, MS 39047-7778
Phone (662) 571-0711
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 |
|---|---|---|---|
| S-5495 | MS | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1785456000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1785456000000",
"number": "1831012590",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "390 AUDUBON CIR",
"city": "BRANDON",
"state": "MS",
"postal_code": "390477778",
"telephone_number": "662-571-0711"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "390 AUDUBON CIR",
"city": "BRANDON",
"state": "MS",
"postal_code": "390477778",
"telephone_number": "662-571-0711"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOORE",
"first_name": "DYLAN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2026-07-31",
"last_updated": "2026-07-31",
"certification_date": "2026-07-31",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "MS",
"license": "S-5495",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brandon, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.