Healthcare Provider Details

I. General information

NPI: 1386563088
Provider Name (Legal Business Name): BAYSIDE DYSPHAGIA DIAGNOSTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 09/27/2026
Certification Date: 09/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 INDEPENDENCE DR STE 7-013
HYANNIS MA
02601-1898
US

IV. Provider business mailing address

100 INDEPENDENCE DR STE 7-013
HYANNIS MA
02601-1898
US

V. Phone/Fax

Practice location:
  • Phone: 508-534-8646
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MELANIE REYNOLDS
Title or Position: OWNER, SPEECH-LANGUAGE PATHOLOGIST
Credential: CCC-SLP
Phone: 508-534-8646