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Deactivated NPI 1720763360 Deactivated / Inactive NPI Male Practitioner

Anthony David Wildfong

Speech-Language Pathologist • Titusville, FL

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Notice of NPI Deactivation & Inactive Practice Status

According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Anthony Wildfong has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date June 20, 2023
NPI Deactivation Date May 07, 2026
Total Practice Duration ~3 Years of Practice (2023 – 2026)

Professional Overview & Biography Verified Profile Summary

Anthony Wildfong was a registered Speech-Language Pathologist practicing in Titusville, FL. Throughout an active medical career spanning 3 years, Anthony Wildfong provided care at the practice location at 1550 JESS PARRISH CT until profile deactivation on 2026-05-07.

Practice Location & Contact Primary Location

Practice Address

1550 Jess Parrish Ct

Titusville, FL 327962147

Telephone 3212692200
Associated Practice Facility / Clinic

Specialty Benchmarks & Practice Insights

Comparative analytics for Speech-Language Pathologist in Titusville, FL

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 8.0 Yrs
State Avg: 16.7 Yrs
Regional Practice Density
46 Specialists

Practicing in Titusville, FL (11640 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

Speech-Language Pathologist Primary Specialty

NUCC Taxonomy Code: 235Z00000X

State License AL 4122

The speech-language pathologist is the professional who engages in clinical services, prevention, advocacy, education, administration, and research in the areas of communication and swallowing across the life span from infancy through geriatrics. Speech-language pathologists address typical and atypical impairments and disorders related to communication and swallowing in the areas of speech sound production, resonance, voice, fluency, language (comprehension and expression), cognition, and feeding and swallowing.

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

14 Associated Practitioners
Paul Pierce , PTA

Physical Therapy Assistant

NPI 1043683337

Physical Therapist Assistant

NPI 1265703425

Physical Therapist

Joy Grove , PT

Physical Therapist

NPI 1275565756

Physical Therapist

Tyvares Murray

Physical Therapy Assistant

NPI 1295452167
Cynthia Schoenleber , OTR

Occupational Therapist

NPI 1306190996

Occupational Therapist Registered

Megan Riggie , PTA

Physical Therapy Assistant

NPI 1306330147

Physical Therapist Assistant

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

7 Historical Events
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NPI Profile Deactivated May 07, 2026

Record deactivated on May 07, 2026

NPI Profile Active June 20, 2023

NPI status registered as active in NPPES database

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Updated Practice Location June 20, 2023

Registered at 1550 JESS PARRISH CT, TITUSVILLE, FL 327962147 (Tel: 3212692200)

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Updated Business Mailing Address June 20, 2023

Registered at 126 HIGHLAND ST, COCOA, FL 329227523 (Tel: 2565509696)

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Provider Name / Credentials Updated June 20, 2023

Recorded as ANTHONY WILDFONG

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Medical Taxonomy / Specialty Registered (Primary Specialty) June 20, 2023

Speech-Language Pathologist (License #4122 in AL)

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Initial NPI Registration & Enumeration June 20, 2023

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1720763360
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: June 20, 2023
Last Update: June 20, 2023
Deactivation Date: May 07, 2026

Mailing Address

126 Highland St

Cocoa, FL 329227523

Phone: 2565509696

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

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