Provider Demographics
NPI:1154654457
Name:SAIDE, JACLYN SUSSAN (BA, LMT)
Entity Type:Individual
Prefix:
First Name:JACLYN
Middle Name:SUSSAN
Last Name:SAIDE
Suffix:
Gender:F
Credentials:BA, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4037 NW BLITCHTON RD
Mailing Address - Street 2:#19D
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34482-8526
Mailing Address - Country:US
Mailing Address - Phone:352-425-0916
Mailing Address - Fax:
Practice Address - Street 1:4037 NW BLITCHTON RD
Practice Address - Street 2:#19D
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34482-8526
Practice Address - Country:US
Practice Address - Phone:352-425-0916
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-17
Last Update Date:2009-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA56987225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist