Provider Demographics
NPI:1962871269
Name:REYES, MARIELYS
Entity type:Individual
Prefix:MRS
First Name:MARIELYS
Middle Name:
Last Name:REYES
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 1:11800 SW 18TH ST
Mailing Address - Street 2:APT# 113
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-1625
Mailing Address - Country:US
Mailing Address - Phone:786-200-4460
Mailing Address - Fax:
Practice Address - Street 1:9500 NW 77TH AVE
Practice Address - Street 2:BAY# 3
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33016-2530
Practice Address - Country:US
Practice Address - Phone:786-429-7713
Practice Address - Fax:786-391-2963
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-17
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSI25532355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant