Provider Demographics
NPI:1871310243
Name:PRIEDE, AMELIA ADAIR
Entity type:Individual
Prefix:
First Name:AMELIA
Middle Name:ADAIR
Last Name:PRIEDE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4131 HEMINGWAY DR
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34293-5249
Mailing Address - Country:US
Mailing Address - Phone:352-573-1455
Mailing Address - Fax:
Practice Address - Street 1:992 TAMIAMI TRL UNIT H2
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33953-3868
Practice Address - Country:US
Practice Address - Phone:941-888-4710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-25
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSI7403235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist