Healthcare Provider Details

I. General information

NPI: 1194750927
Provider Name (Legal Business Name): LYDIA DACHELL REID SLPD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 06/14/2026
Certification Date: 06/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7191 W OAKLAND PARK BLVD
LAUDERHILL FL
33313-1050
US

IV. Provider business mailing address

5077 NW 7TH ST APT 1604
MIAMI FL
33126-3467
US

V. Phone/Fax

Practice location:
  • Phone: 954-474-8330
  • Fax:
Mailing address:
  • Phone: 954-775-5013
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA 4876
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: