Provider Demographics
NPI:1326375601
Name:ROMAN, DAISY (MED)
Entity Type:Individual
Prefix:MS
First Name:DAISY
Middle Name:
Last Name:ROMAN
Suffix:
Gender:F
Credentials:MED
Other - Prefix:MS
Other - First Name:DAISY
Other - Middle Name:
Other - Last Name:ROMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS
Mailing Address - Street 1:3739 BRIAR RUN DR
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-9633
Mailing Address - Country:US
Mailing Address - Phone:407-230-2357
Mailing Address - Fax:
Practice Address - Street 1:17301 PAGONIA DR STE 220A
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-5996
Practice Address - Country:US
Practice Address - Phone:407-602-8567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-07
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 101YM0800X, 261QM0801X
FLMH14569101YP2500X, 101YM0800X, 101YM0800X
FL811173101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1548915226OtherNPI