Healthcare Provider Details

I. General information

NPI: 1992569040
Provider Name (Legal Business Name): THE BLUE DOOR INFANT AND MATERNAL WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2024
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3030 STARKEY BLVD STE 272
NEW PORT RICHEY FL
34655-2175
US

IV. Provider business mailing address

19103 BECKETT DR
ODESSA FL
33556-2266
US

V. Phone/Fax

Practice location:
  • Phone: 330-445-9006
  • Fax:
Mailing address:
  • Phone: 330-445-9006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: RACHEL HUDSON
Title or Position: SPEECH LANGUAGE PATHOLOGIST
Credential: MA, CCC-SLP, IBCLC
Phone: 339-445-9006