NPIMap

Organization Active NPI

Mary M Pellegrino

  • Speech-Language Pathologist
  • Tallahassee, FL
National Provider Identifier
1912965856
Registry record updated Apr 12, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
SA2251 Issued in FL
Legal business name
MARY M PELLEGRINO
Practice address
3215 Capital Medical Blvd
Tallahassee, FL 32308-4413
Phone
(850) 878-0609
NPI assigned
May 2, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 12, 2012

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

Authorized official

Name
Mary PellegrinoNPI 1609998509
Title
Owner
Phone
(850) 878-0609

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language PathologistGroup: 193400000X SINGLE SPECIALTY GROUP 235Z00000X SA2251 FL Primary

Addresses

Primary practice location

3215 Capital Medical Blvd
Tallahassee, FL 32308-4413

Mailing address

3215 Capital Medical Blvd
Tallahassee, FL 32308-4413

Other identifiers 1

IdentifierTypeStateIssuer
880934800MedicaidFL

National Provider Directory

National Provider Directory

Locations

3215 Capital Medical Blvd
Tallahassee, FL 32308
Phone (850) 878-0609

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1146528000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1334188800000",
    "number": "1912965856",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3215 CAPITAL MEDICAL BLVD",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "323084413"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3215 CAPITAL MEDICAL BLVD",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "323084413",
            "telephone_number": "850-878-0609"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARY M PELLEGRINO",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-02",
        "last_updated": "2012-04-12",
        "status": "A",
        "authorized_official_last_name": "PELLEGRINO",
        "authorized_official_first_name": "MARY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "850-878-0609"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Speech-Language Pathologist",
            "state": "FL",
            "license": "SA2251",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "880934800",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tallahassee, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2012; 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.