Individual provider Active NPI

Ruqaiya S Dalal

  • Speech-Language Pathologist
  • Dacula, GA
National Provider Identifier
1861228470
Registry record updated Sep 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
PCET004130 Issued in GA
Practice address
3615 Braselton Hwy Ste 103
Dacula, GA 30019-5907
Phone
(678) 377-9634
Fax
(678) 377-9609
NPI assigned
Sep 10, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 10, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X PCET004130 GA Primary

Addresses

Primary practice location

3615 Braselton Hwy Ste 103
Dacula, GA 30019-5907

Mailing address

3615 Braselton Hwy Ste 103
Dacula, GA 30019-5907
Phone (678) 377-9634

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

Care Compare profile

Medicare Care Compare
Specialty
Qualified Speech Language Pathologist
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Empowerme Rehabilitation Georgia, LLCGroup PAC ID 4284063835, 80 clinicians

Practice addresses (Care Compare)

5373 Thompson Mill Rd
Hoschton, GA 30548-4037
Phone (770) 609-3343

5610 Hampton Park Dr
Cumming, GA 30041-4004
Phone (470) 866-5540

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PCET004130GAMDSpeech-Language Pathologist

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1725926400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725926400000",
    "number": "1861228470",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3615 BRASELTON HWY STE 103",
            "city": "DACULA",
            "state": "GA",
            "postal_code": "300195907",
            "telephone_number": "678-377-9634",
            "fax_number": "678-377-9609"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3615 BRASELTON HWY STE 103",
            "city": "DACULA",
            "state": "GA",
            "postal_code": "300195907",
            "telephone_number": "678-377-9634",
            "fax_number": "678-377-9609"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DALAL",
        "first_name": "RUQAIYA",
        "middle_name": "S",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-09-10",
        "last_updated": "2024-09-10",
        "certification_date": "2024-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "GA",
            "license": "PCET004130",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dacula, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.