Active NPI
Shelby Elisa Whitsell Edmonds, M.S., CCC-SLP
- Speech-Language Pathologist
- Southaven, MS
National Provider Identifier
1982209581
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 6575
- Practice address
- 2628 Dawnwood Cir N
Southaven, MS 38672-2310 - Phone
- (901) 461-4677
- NPI assigned
- Dec 1, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 6575 | TN | Primary |
Addresses
Primary practice location
2628 Dawnwood Cir N
Southaven, MS 38672-2310
Mailing address
2628 Dawnwood Cir N
Southaven, MS 38672-2310
Phone (901) 461-4677
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
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6575 | TN | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1606780800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1606780800000",
"number": "1982209581",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2628 DAWNWOOD CIR N",
"city": "SOUTHAVEN",
"state": "MS",
"postal_code": "386722310",
"telephone_number": "901-461-4677"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2628 DAWNWOOD CIR N",
"city": "SOUTHAVEN",
"state": "MS",
"postal_code": "386722310",
"telephone_number": "901-461-4677"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EDMONDS",
"first_name": "SHELBY",
"middle_name": "ELISA WHITSELL",
"credential": "M.S., CCC-SLP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-12-01",
"last_updated": "2020-12-01",
"certification_date": "2020-12-01",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "TN",
"license": "6575",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Southaven, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.