Healthcare Provider Details

I. General information

NPI: 1780489328
Provider Name (Legal Business Name): TAYLA ALDEA COSTA M.S., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/18/2025
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 METACOM AVE
BRISTOL RI
02809-8508
US

IV. Provider business mailing address

145 KEARNS AVE
TIVERTON RI
02878-1523
US

V. Phone/Fax

Practice location:
  • Phone: 401-600-1670
  • Fax: 401-366-8005
Mailing address:
  • Phone: 774-330-8131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number100193
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: