Individual provider Active NPI

Nathaly Andrea Bustos Alfonso

  • Speech-Language Pathologist
  • Baltimore, MD
National Provider Identifier
1972118875
Registry record updated Jul 13, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
Practice address
2921 Stranden Rd
Baltimore, MD 21230-2941
Phone
(617) 803-1485
NPI assigned
Sep 9, 2020
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 13, 2022

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

Specialties & licenses 1

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

Addresses

Primary practice location

2921 Stranden Rd
Baltimore, MD 21230-2941

Mailing address

19169 Roman Way
Montgomery Village, MD 20886-5064
Phone (617) 803-1485

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

NPI Registry JSON

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

{
    "created_epoch": "1599609600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1657670400000",
    "number": "1972118875",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19169 ROMAN WAY",
            "city": "MONTGOMERY VILLAGE",
            "state": "MD",
            "postal_code": "208865064",
            "telephone_number": "617-803-1485"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2921 STRANDEN RD",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212302941",
            "telephone_number": "617-803-1485"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUSTOS ALFONSO",
        "first_name": "NATHALY",
        "middle_name": "ANDREA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-09-09",
        "last_updated": "2022-07-13",
        "certification_date": "2020-09-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2022; 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.