Active NPI
Reginald Dywane Byrd
- Adult Companion
- Havana, FL
National Provider Identifier
1629314471
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Adult Companion
- License
- AL12271
- Practice address
- 328 SE 4TH St
Havana, FL 32333-2150 - Phone
- (850) 539-6282
- NPI assigned
- Dec 26, 2012
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Adult Companion | 372600000X | AL12271 | FL | Primary |
Addresses
Primary practice location
328 SE 4TH St
Havana, FL 32333-2150
Mailing address
328 SE 4TH St
Havana, FL 32333-2150
Phone (850) 539-6282
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 466375 | Other | FL | MEDICAID ENROLLMENT FILE NUMBER |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AL12271 | FL | MD | Adult Companion |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1356480000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1356480000000",
"number": "1629314471",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "328 SE 4TH ST",
"city": "HAVANA",
"state": "FL",
"postal_code": "323332150",
"telephone_number": "850-539-6282"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "328 SE 4TH ST",
"city": "HAVANA",
"state": "FL",
"postal_code": "323332150",
"telephone_number": "850-539-6282"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BYRD",
"first_name": "REGINALD",
"middle_name": "DYWANE",
"name_prefix": "Mr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-12-26",
"last_updated": "2012-12-26",
"status": "A"
},
"taxonomies": [
{
"code": "372600000X",
"taxonomy_group": "",
"desc": "Adult Companion",
"state": "FL",
"license": "AL12271",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICAID ENROLLMENT FILE NUMBER",
"identifier": "466375",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Havana, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 26, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.