Healthcare Provider Details

I. General information

NPI: 1629902804
Provider Name (Legal Business Name): JAMES BLAIDA MSP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 ALICE DR
SUMTER SC
29150-1905
US

IV. Provider business mailing address

545 BOOTS BRANCH RD
SUMTER SC
29153-8028
US

V. Phone/Fax

Practice location:
  • Phone: 803-774-5201
  • Fax:
Mailing address:
  • Phone: 847-513-3625
  • 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:
Title or Position:
Credential:
Phone: