Nicole Yvonne Crandall

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

SA 6159 Issued in FL

Practice address

18425 NW 2ND Ave PH 5
Miami Gardens, FL 33169-4524

Phone

(954) 257-7473

NPI assigned

Sep 4, 2010

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1283558400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1621382400000",
    "number": "1891002358",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2817 SHELBURNE WAY",
            "city": "SAINT CLOUD",
            "state": "FL",
            "postal_code": "347728909",
            "telephone_number": "407-873-6101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18425 NW 2ND AVE PH 5",
            "city": "MIAMI GARDENS",
            "state": "FL",
            "postal_code": "331694524",
            "telephone_number": "954-257-7473"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2425 Tybee Rd",
            "address_purpose": "LOCATION",
            "city": "Saint Cloud",
            "state": "FL",
            "postal_code": "347697120",
            "country_code": "US",
            "telephone_number": "407-873-6101",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CRANDALL",
        "first_name": "NICOLE",
        "middle_name": "YVONNE",
        "name_prefix": "Miss",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-09-04",
        "last_updated": "2021-05-19",
        "certification_date": "2021-05-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "FL",
            "license": "SA 6159",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Speech-Language Pathologist in Miami Gardens, FL
• Providers in Miami Gardens, FL by specialty
• Speech-Language Pathologist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2021; 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.