Healthcare Provider Details

I. General information

NPI: 1255277729
Provider Name (Legal Business Name): LIDA BREIJO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1616 JORK RD STE 401-402
JACKSONVILLE FL
32207-2491
US

IV. Provider business mailing address

8181 A C SKINNER PKWY
JACKSONVILLE FL
32256-5216
US

V. Phone/Fax

Practice location:
  • Phone: 904-662-7093
  • Fax:
Mailing address:
  • Phone: 717-205-7813
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberRBT-25-480653
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: