Individual provider Active NPI

Reda Ahmad Shihadeh, OTR/L

  • Gerontology Occupational Therapist
  • Saint Johns, FL
National Provider Identifier
1255204103
Registry record updated Sep 26, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Occupational TherapistTaxonomy code 225XG0600X
License
6341 Issued in FL
Practice address
200 Woodfield LN
Saint Johns, FL 32259-6302
Phone
(904) 874-1223
NPI assigned
Sep 26, 2025
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 26, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gerontology Occupational Therapist 225XG0600X 6341 FL Primary

Addresses

Primary practice location

200 Woodfield LN
Saint Johns, FL 32259-6302

Mailing address

200 Woodfield LN
Saint Johns, FL 32259-6302
Phone (904) 874-1223

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20251008003391 FL Practitioner - Occupational Therapist in Private Practice 8628575321 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Occupational Therapist in Private Practice
Education
Other, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ap Therapy LLCGroup PAC ID 9032552559, 56 clinicians

Practice addresses (Care Compare)

1297 US Hwy 27 N
Lake Placid, FL 33852-7907
Phone (800) 380-9153

9601 Southbrook Dr
Jacksonville, FL 32256-0601
Phone (800) 380-9153

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
6341FLMDOptician

Practice roles

OrganizationSpecialtyStatusNew patients
Ap Therapy LLC CurrentSince Oct 1, 2025 Accepting new patients
Ap Therapy LLC CurrentSince Oct 1, 2025 Accepting new patients

Locations

1297 US Highway 27 N
Lake Placid, FL 33852
Phone (407) 276-5023

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1758844800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1758844800000",
    "number": "1255204103",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 WOODFIELD LN",
            "city": "SAINT JOHNS",
            "state": "FL",
            "postal_code": "322596302",
            "telephone_number": "904-874-1223"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 WOODFIELD LN",
            "city": "SAINT JOHNS",
            "state": "FL",
            "postal_code": "322596302",
            "telephone_number": "904-874-1223"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHIHADEH",
        "first_name": "REDA",
        "middle_name": "AHMAD",
        "credential": "OTR/L",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2025-09-26",
        "last_updated": "2025-09-26",
        "certification_date": "2025-09-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225XG0600X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Gerontology",
            "state": "FL",
            "license": "6341",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Johns, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.