Healthcare Provider Details

I. General information

NPI: 1881327252
Provider Name (Legal Business Name): NINA MARIE BYRNE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2022
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5647 GULF DR
NEW PORT RICHEY FL
34652-4019
US

IV. Provider business mailing address

5647 GULF DR
NEW PORT RICHEY FL
34652-4019
US

V. Phone/Fax

Practice location:
  • Phone: 813-435-3355
  • Fax:
Mailing address:
  • Phone: 813-435-3355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number13704
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: