{
"Npi": {
"NPI": "1073839908",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "SUNSET SPEECH AND LANGUAGE PATHOLOGY, LLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "5901 SW 74TH ST",
"SecondLineMailingAddress": "SUITE 411",
"MailingAddressCityName": "SOUTH MIAMI",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "33143-5165",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "305-740-9688",
"MailingAddressFaxNumber": "305-428-9521",
"FirstLinePracticeLocationAddress": "5901 SW 74TH ST",
"SecondLinePracticeLocationAddress": "SUITE 411",
"PracticeLocationAddressCityName": "SOUTH MIAMI",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "33143-5165",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "305-740-9688",
"PracticeLocationAddressFaxNumber": "305-428-9521",
"EnumerationDate": "04/16/2010",
"LastUpdateDate": "05/31/2013",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BAETIONG",
"AuthorizedOfficialFirstName": "MELISSA",
"AuthorizedOfficialMiddleName": "BERRY",
"AuthorizedOfficialTitle": "DIRECTOR",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "M.A., CCC-SLP",
"AuthorizedOfficialTelephoneNumber": "305-740-9688",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "252Y00000X",
"TaxonomyName": "Early Intervention Provider Agency",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "251C00000X",
"TaxonomyName": "Developmentally Disabled Services Day Training Agency",
"LicenseNumber": "SA8367",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}