MEDICARE: KEISHLA MARIE REYES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2355S0801X	Speech-Language Assistant	4001	PR

General Provider Information

NPI Number	:	1891670113
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEISHLA MARIE REYES

Provider Business Mailing Address
First Line	:	HC 6 BOX 6812
Second Line	:
City	:	GUAYNABO
State	:	PR
Zip	:	00971-9567
Country	:	US
Telephone Number	:	787-616-9071
Fax Number	:

Provider Business Practice Location Address
First Line	:	2U5 AVE LAUREL
Second Line	:
City	:	BAYAMON
State	:	PR
Zip	:	00956-3374
Country	:	US
Telephone Number	:	787-233-2747
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/06/2025
Last Update Date	:	08/06/2025

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Directions to “ KEISHLA MARIE REYES ” Practice Location

Language	Start Address	Practice Location

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