Provider Demographics
NPI:1982007472
Name:REID, MYISHIA (BS)
Entity Type:Individual
Prefix:
First Name:MYISHIA
Middle Name:
Last Name:REID
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 MINE ROAD
Mailing Address - Street 2:
Mailing Address - City:MIDWAY
Mailing Address - State:FL
Mailing Address - Zip Code:32343
Mailing Address - Country:US
Mailing Address - Phone:850-284-6460
Mailing Address - Fax:
Practice Address - Street 1:324 MINE ROAD
Practice Address - Street 2:
Practice Address - City:MIDWAY
Practice Address - State:FL
Practice Address - Zip Code:32343
Practice Address - Country:US
Practice Address - Phone:850-284-6460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-29
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator