Kelly Brian Rediske

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

5838 Issued in CA

Practice address

589 E Vartikian Ave
Fresno, CA 93710-5330

Phone

(559) 696-4063

NPI assigned

Oct 21, 2009

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Kelly Brian Shea Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1256083200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1256083200000",
    "number": "1861728149",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "589 E VARTIKIAN AVE",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937105330"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "589 E VARTIKIAN AVE",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937105330",
            "telephone_number": "559-696-4063"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REDISKE",
        "first_name": "KELLY",
        "middle_name": "BRIAN",
        "name_prefix": "Mrs.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-10-21",
        "last_updated": "2009-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "CA",
            "license": "5838",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLY",
            "last_name": "SHEA",
            "middle_name": "BRIAN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Sunayana V. Reddy, M.D.
• Umapathi P. Reddy, MD
• Usha Reddy, M.D.
• Chad Sherwood Reder, MD
• Shawn Tyler Redfield Jr.
• Heather Allyn Redmond-Archer, RN
• Katherine Alexandra Redwine, PH.D.
• Tyra Paige Reece-Smith
• Haley Briana Reed Jackson
• Wendy Dawn Reed Perez, P.A.

• Speech-Language Pathologist in Fresno, CA
• Providers in Fresno, CA by specialty
• Speech-Language Pathologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2009; 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.