Active NPI
Ivonne Carmen Randolph, MACCCSLP
- Speech-Language Pathologist
- Port Orange, FL
National Provider Identifier
1922148451
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- SA 1206
- Practice address
- 5791 Falling Tree LN
Port Orange, FL 32127-7993 - Phone
- (407) 595-2710
- NPI assigned
- Feb 7, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Developmental Therapist | 222Q00000X | |||
| Early Intervention Provider Agency | 252Y00000X | |||
| Speech-Language Pathologist | 235Z00000X | SA 1206 | FL | Primary |
Addresses
Primary practice location
5791 Falling Tree LN
Port Orange, FL 32127-7993
Mailing address
5791 Falling Tree LN
Port Orange, FL 32127-7993
Phone (407) 595-2710
Other practice location 1
2219 S Woodland Blvd
Deland, FL 32720-8628
Phone (386) 736-9849
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 884535200 | Medicaid | FL |
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SA 1206 | FL | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170806400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1739664000000",
"number": "1922148451",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5791 FALLING TREE LN",
"city": "PORT ORANGE",
"state": "FL",
"postal_code": "321277993",
"telephone_number": "407-595-2710"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5791 FALLING TREE LN",
"city": "PORT ORANGE",
"state": "FL",
"postal_code": "321277993",
"telephone_number": "407-595-2710"
}
],
"practiceLocations": [
{
"address_1": "2219 S Woodland Blvd",
"address_purpose": "LOCATION",
"city": "Deland",
"state": "FL",
"postal_code": "327208628",
"country_code": "US",
"telephone_number": "386-736-9849",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "RANDOLPH",
"first_name": "IVONNE",
"middle_name": "CARMEN",
"name_prefix": "Mrs.",
"credential": "MACCCSLP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-02-07",
"last_updated": "2025-02-16",
"certification_date": "2025-02-16",
"status": "A"
},
"taxonomies": [
{
"code": "222Q00000X",
"taxonomy_group": "",
"desc": "Developmental Therapist",
"state": null,
"license": null,
"primary": false
},
{
"code": "252Y00000X",
"taxonomy_group": "",
"desc": "Early Intervention Provider Agency",
"state": null,
"license": null,
"primary": false
},
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "FL",
"license": "SA 1206",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "884535200",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Port Orange, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.