Provider Demographics
NPI:1306155213
Name:DIAZ, LINDSEY (CNIM, BS)
Entity type:Individual
Prefix:
First Name:LINDSEY
Middle Name:
Last Name:DIAZ
Suffix:
Gender:F
Credentials:CNIM, BS
Other - Prefix:
Other - First Name:LINDSEY
Other - Middle Name:
Other - Last Name:MCKELVEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNIM BS
Mailing Address - Street 1:8955 70TH WAY N
Mailing Address - Street 2:
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33782-4564
Mailing Address - Country:US
Mailing Address - Phone:727-251-2613
Mailing Address - Fax:
Practice Address - Street 1:2150 TOWN SQUARE PL
Practice Address - Street 2:SUITE 290
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-1465
Practice Address - Country:US
Practice Address - Phone:281-768-6730
Practice Address - Fax:281-768-6766
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-28
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CNIM 1727246ZE0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic