Provider Demographics
NPI:1710619358
Name:MEJIA, LIDYA (MED, CFY-SLP)
Entity Type:Individual
Prefix:
First Name:LIDYA
Middle Name:
Last Name:MEJIA
Suffix:
Gender:F
Credentials:MED, CFY-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1822 MAYFAIR RD
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32303-3538
Mailing Address - Country:US
Mailing Address - Phone:850-629-9105
Mailing Address - Fax:855-921-1902
Practice Address - Street 1:1822 MAYFAIR RD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32303-3538
Practice Address - Country:US
Practice Address - Phone:850-629-9105
Practice Address - Fax:855-921-1902
Is Sole Proprietor?:No
Enumeration Date:2022-06-30
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ10683235Z00000X
FLSA21526235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSZ10683OtherFLORIDA DEPARTMENT OF HEALTH