Healthcare Provider Details

I. General information

NPI: 1871330647
Provider Name (Legal Business Name): TAIFA NESLIE LAROCHELLE-HALL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2024
Last Update Date: 07/10/2024
Certification Date: 07/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 OAKWOOD BLVD STE 130
HOLLYWOOD FL
33020-1937
US

IV. Provider business mailing address

14895 NE 18TH AVE APT 4R
NORTH MIAMI FL
33181-1125
US

V. Phone/Fax

Practice location:
  • Phone: 954-925-3844
  • Fax:
Mailing address:
  • Phone: 786-514-8775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSI7161
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: