MEDICARE: LIDA BREIJO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	RBT-25-480653	FL

General Provider Information

NPI Number	:	1255277729
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LIDA BREIJO

Provider Business Mailing Address
First Line	:	8181 A C SKINNER PKWY
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-5216
Country	:	US
Telephone Number	:	717-205-7813
Fax Number	:

Provider Business Practice Location Address
First Line	:	1616 JORK RD STE 401-402
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32207-2491
Country	:	US
Telephone Number	:	904-662-7093
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/27/2026
Last Update Date	:	04/27/2026

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Directions to “ LIDA BREIJO ” Practice Location

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