Provider Demographics
NPI:1417454737
Name:MACHADO, DAINA Y (BS)
Entity Type:Individual
Prefix:
First Name:DAINA
Middle Name:Y
Last Name:MACHADO
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7856 SUGAR PINE BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33810-1383
Mailing Address - Country:US
Mailing Address - Phone:863-844-1503
Mailing Address - Fax:
Practice Address - Street 1:7856 SUGAR PINE BLVD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33810-1383
Practice Address - Country:US
Practice Address - Phone:863-844-1503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-12
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health