1487870549 NPI number — MRS. TERANYA SHAYE BOYKINS MS, CCC-SLP

Table of content: MRS. TERANYA SHAYE BOYKINS MS, CCC-SLP (NPI 1487870549)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487870549 NPI number — MRS. TERANYA SHAYE BOYKINS MS, CCC-SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOYKINS
Provider First Name:
TERANYA
Provider Middle Name:
SHAYE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MS, CCC-SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
JOHNSON
Provider Other First Name:
TERANYA
Provider Other Middle Name:
SHAYE
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MS, CCC-SLP
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1487870549
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/18/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
122 E MAIN ST # 304
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKELAND
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33801-4655
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
863-732-9955
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
602 VONDERBURG DR
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
BRANDON
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33511-5900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
863-617-9400
Provider Business Practice Location Address Fax Number:
863-688-9858
Provider Enumeration Date:
04/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  SA7686 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 109131600 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 891535100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 109131600 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com