Provider Demographics
NPI:1386963353
Name:CAMPBELL, ALYSSA SHAFII (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:ALYSSA
Middle Name:SHAFII
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:NASRINE
Other - Last Name:SHAFII
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:10601 ASHTEAD WOOD CT
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626-2577
Mailing Address - Country:US
Mailing Address - Phone:813-251-4381
Mailing Address - Fax:813-251-6407
Practice Address - Street 1:10601 ASHTEAD WOOD CT
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626-2577
Practice Address - Country:US
Practice Address - Phone:813-251-4381
Practice Address - Fax:813-251-6407
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-28
Last Update Date:2014-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA10818235Z00000X
222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002904300Medicaid