Healthcare Provider Details

I. General information

NPI: 1720265960
Provider Name (Legal Business Name): NEDRA REID SLP-A
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2008
Last Update Date: 01/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3157 N UNIVERSITY DR SUITE 103
HOLLYWOOD FL
33024-2258
US

IV. Provider business mailing address

3157 N UNIVERSITY DR SUITE 103
HOLLYWOOD FL
33024-2258
US

V. Phone/Fax

Practice location:
  • Phone: 954-442-9422
  • Fax: 954-442-9150
Mailing address:
  • Phone: 954-442-9422
  • Fax: 954-442-9150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSI1254
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: