Provider Demographics
NPI:1093016792
Name:BERGIDA, BRACHA DEVORAH
Entity Type:Individual
Prefix:MRS
First Name:BRACHA
Middle Name:DEVORAH
Last Name:BERGIDA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BRACHA
Other - Middle Name:DEVORAH
Other - Last Name:LUBAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1341 NE 173RD ST
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33162-1252
Mailing Address - Country:US
Mailing Address - Phone:347-848-5638
Mailing Address - Fax:
Practice Address - Street 1:2265 NE 164TH ST
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33160-3703
Practice Address - Country:US
Practice Address - Phone:305-949-7665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-11
Last Update Date:2010-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ 5279235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist