Healthcare Provider Details

I. General information

NPI: 1851244693
Provider Name (Legal Business Name): GYDED LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2026
Last Update Date: 03/03/2026
Certification Date: 03/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1209 MOUNTAIN ROAD PL NE # 7053
ALBUQUERQUE NM
87110-7845
US

IV. Provider business mailing address

8735 DUNWOODY PL STE 8478
ATLANTA GA
30350-2995
US

V. Phone/Fax

Practice location:
  • Phone: 404-590-1442
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: SHAQUANTA BOYD
Title or Position: OWNER
Credential: PMHNP-BC
Phone: 404-590-1442