MEDICARE: MS. NEDRA REID SLP-A

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	2355S0801X	Speech-Language Assistant	SI1254	FL

General Provider Information

NPI Number	:	1720265960
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. NEDRA REID SLP-A

Provider Business Mailing Address
First Line	:	3157 N UNIVERSITY DR
Second Line	:	SUITE 103
City	:	HOLLYWOOD
State	:	FL
Zip	:	33024-2258
Country	:	US
Telephone Number	:	954-442-9422
Fax Number	:	954-442-9150

Provider Business Practice Location Address
First Line	:	3157 N UNIVERSITY DR
Second Line	:	SUITE 103
City	:	HOLLYWOOD
State	:	FL
Zip	:	33024-2258
Country	:	US
Telephone Number	:	954-442-9422
Fax Number	:	954-442-9150

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

Provider Enumeration Date	:	01/30/2008
Last Update Date	:	01/30/2008

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