Healthcare Provider Details

I. General information

NPI: 1669302154
Provider Name (Legal Business Name): TIFFANY MADDOX MA CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 CORNING RD
CARY NC
27518-9229
US

IV. Provider business mailing address

6020 ANTIGUA RUN
KNIGHTDALE NC
27545-9499
US

V. Phone/Fax

Practice location:
  • Phone: 919-431-4700
  • Fax:
Mailing address:
  • Phone: 919-441-5002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number3533
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: