Provider Demographics
NPI:1255204103
Name:SHIHADEH, REDA AHMAD (OTR/L)
Entity type:Individual
Prefix:
First Name:REDA
Middle Name:AHMAD
Last Name:SHIHADEH
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 WOODFIELD LN
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHNS
Mailing Address - State:FL
Mailing Address - Zip Code:32259-6302
Mailing Address - Country:US
Mailing Address - Phone:904-874-1223
Mailing Address - Fax:
Practice Address - Street 1:200 WOODFIELD LN
Practice Address - Street 2:
Practice Address - City:SAINT JOHNS
Practice Address - State:FL
Practice Address - Zip Code:32259-6302
Practice Address - Country:US
Practice Address - Phone:904-874-1223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-26
Last Update Date:2025-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6341225XG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology