MEDICARE: BAYSIDE SPEECH THERAPY, INC.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	225X00000X	Occupational Therapist
2	235Z00000X	Speech-Language Pathologist
3	261Q00000X	Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578954962
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAYSIDE SPEECH THERAPY, INC.

Provider Business Mailing Address
First Line	:	5647 GULF DR
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34652-4019
Country	:	US
Telephone Number	:	813-435-3355
Fax Number	:

Provider Business Practice Location Address
First Line	:	5647 GULF DR
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34652-4019
Country	:	US
Telephone Number	:	813-435-3355
Fax Number	:

Authorized Official
Title or Position	:	SPEECH-LANGUAGE PATHOLOGIST
Name	:	MRS. NICOLE M YATES
Credential	:	MS CCC-SLP
Telephone Number	:	813-944-9594

Provider Enumeration Date	:	02/07/2015
Last Update Date	:	08/02/2024

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Directions to “BAYSIDE SPEECH THERAPY, INC. ” Practice Location

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