Individual provider Active NPI

Rachel Shishov

  • Speech-Language Pathologist
  • Palm Beach Gardens, FL
National Provider Identifier
1861791527
Registry record updated Apr 18, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
SA21309 Issued in FL
Practice address
347 Hiatt Dr
Palm Beach Gardens, FL 33418-7106
Phone
(561) 621-4366
NPI assigned
Mar 21, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 18, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X SA21309 FL Primary
Speech-Language Pathologist 235Z00000X NY

Addresses

Primary practice location

347 Hiatt Dr
Palm Beach Gardens, FL 33418-7106

Mailing address

9638 Shepard PL
Wellington, FL 33414-6420
Phone (631) 836-4747

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)
Enrolled

NPI Registry JSON

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

{
    "created_epoch": "1300665600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1681776000000",
    "number": "1861791527",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9638 SHEPARD PL",
            "city": "WELLINGTON",
            "state": "FL",
            "postal_code": "334146420",
            "telephone_number": "631-836-4747"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "347 HIATT DR",
            "city": "PALM BEACH GARDENS",
            "state": "FL",
            "postal_code": "334187106",
            "telephone_number": "561-621-4366"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHISHOV",
        "first_name": "RACHEL",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-03-21",
        "last_updated": "2023-04-18",
        "certification_date": "2023-04-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "FL",
            "license": "SA21309",
            "primary": true
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NY",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Palm Beach Gardens, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2023; 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.