MEDICARE: MRS. MARIELYS REYES

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	SI2553	FL

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	:	1962871269
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARIELYS REYES

Provider Business Mailing Address
First Line	:	11800 SW 18TH ST
Second Line	:	APT# 113
City	:	MIAMI
State	:	FL
Zip	:	33175-1625
Country	:	US
Telephone Number	:	786-200-4460
Fax Number	:

Provider Business Practice Location Address
First Line	:	9500 NW 77TH AVE
Second Line	:	BAY# 3
City	:	MIAMI LAKES
State	:	FL
Zip	:	33016-2530
Country	:	US
Telephone Number	:	786-429-7713
Fax Number	:	786-391-2963

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

Provider Enumeration Date	:	09/17/2015
Last Update Date	:	09/17/2015

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Directions to “ MRS. MARIELYS REYES ” Practice Location

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