Provider Demographics
NPI:1528509536
Name:REYNALDOS, GRAZIELLA (SLP)
Entity type:Individual
Prefix:
First Name:GRAZIELLA
Middle Name:
Last Name:REYNALDOS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 PENNSYLVANIA AVE APT 11
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33139-4058
Mailing Address - Country:US
Mailing Address - Phone:347-920-1733
Mailing Address - Fax:
Practice Address - Street 1:1400 PENNSYLVANIA AVE APT 11
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33139-4058
Practice Address - Country:US
Practice Address - Phone:347-920-1733
Practice Address - Fax:512-916-1532
Is Sole Proprietor?:No
Enumeration Date:2017-03-10
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110922235Z00000X
NY027070235Z00000X
FLSA19277235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist