Provider Demographics
NPI:1760249726
Name:CLYDE, ARYEH (CM - CERTIFIED MOHEL)
Entity Type:Individual
Prefix:
First Name:ARYEH
Middle Name:
Last Name:CLYDE
Suffix:
Gender:M
Credentials:CM - CERTIFIED MOHEL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13506 LITTLE LAKE PL
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-4134
Mailing Address - Country:US
Mailing Address - Phone:917-943-2635
Mailing Address - Fax:
Practice Address - Street 1:13506 LITTLE LAKE PL
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-4134
Practice Address - Country:US
Practice Address - Phone:917-943-2635
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-05
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374K00000XNursing Service Related ProvidersReligious Nonmedical Practitioner