Provider Demographics
NPI:1457476970
Name:PANARIELLO, DENISE
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:PANARIELLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:541 GREEN RIVER LN
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33325-1246
Mailing Address - Country:US
Mailing Address - Phone:954-732-8245
Mailing Address - Fax:954-779-2316
Practice Address - Street 1:541 GREEN RIVER LN
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33325-1246
Practice Address - Country:US
Practice Address - Phone:954-732-8245
Practice Address - Fax:954-779-2316
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X, 222Q00000X
FLOT14863225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL811647400Medicaid
FL766735300Medicaid