Provider Demographics
NPI:1326167313
Name:MANZELLA-DAILEY, DONNA (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:MANZELLA-DAILEY
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 FOREST PARK DR
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32962-4652
Mailing Address - Country:US
Mailing Address - Phone:716-868-3173
Mailing Address - Fax:
Practice Address - Street 1:35 FOREST PARK DR
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32962-4652
Practice Address - Country:US
Practice Address - Phone:716-868-3173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA11499222Q00000X
FLSA 11499222Q00000X, 235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL014437000Medicaid
FL020210400Medicaid