NPIMap

Organization Active NPI

Tidalhealth Pediatric Development and Therapy LLC

  • Speech-Language Pathologist
  • Millsboro, DE
National Provider Identifier
1689568404
Registry record updated Jun 5, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
Legal business name
TIDALHEALTH PEDIATRIC DEVELOPMENT AND THERAPY LLC
Practice address
30265 Commerce Dr Unit 204
Millsboro, DE 19966-3595
Phone
(443) 978-6020
NPI assigned
Jun 5, 2025
Last updated
Jun 5, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 5, 2025

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

Authorized official

Name
Jazmine Maree Hollins
Title
Credentialing Specialist
Phone
(704) 799-6824

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language PathologistGroup: 193400000X SINGLE SPECIALTY GROUP 235Z00000X Primary

Addresses

Primary practice location

30265 Commerce Dr Unit 204
Millsboro, DE 19966-3595

Mailing address

30265 Commerce Dr Unit 204
Millsboro, DE 19966-3595
Phone (443) 978-6020

Other practice location 1

2326 Goddard Pkwy Ste D
Salisbury, MD 21801-1126
Phone (443) 978-6020

National Provider Directory

National Provider Directory
Tax ID family
Tidalhealth Pediatric Development and Therapy LLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1749081600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1749081600000",
    "number": "1689568404",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30265 COMMERCE DR UNIT 204",
            "city": "MILLSBORO",
            "state": "DE",
            "postal_code": "199663595",
            "telephone_number": "443-978-6020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30265 COMMERCE DR UNIT 204",
            "city": "MILLSBORO",
            "state": "DE",
            "postal_code": "199663595",
            "telephone_number": "443-978-6020"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2326 Goddard Pkwy Ste D",
            "address_purpose": "LOCATION",
            "city": "Salisbury",
            "state": "MD",
            "postal_code": "218011126",
            "country_code": "US",
            "telephone_number": "443-978-6020",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "TIDALHEALTH PEDIATRIC DEVELOPMENT AND THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-06-05",
        "last_updated": "2025-06-05",
        "certification_date": "2025-06-05",
        "status": "A",
        "authorized_official_last_name": "HOLLINS",
        "authorized_official_first_name": "JAZMINE",
        "authorized_official_middle_name": "MAREE",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "704-799-6824"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Millsboro, DE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.