Provider Demographics
NPI:1497311385
Name:BOSTIC, DASHA NAIYM
Entity Type:Individual
Prefix:
First Name:DASHA
Middle Name:NAIYM
Last Name:BOSTIC
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:DASHA
Other - Middle Name:
Other - Last Name:BOSTIC
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DASHA BOSTIC
Mailing Address - Street 1:6023 NW 22ND AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33142-7805
Mailing Address - Country:US
Mailing Address - Phone:305-495-7140
Mailing Address - Fax:
Practice Address - Street 1:6023 NW 22ND AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33142-7805
Practice Address - Country:US
Practice Address - Phone:305-495-7140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-15
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No372500000XNursing Service Related ProvidersChore Provider
No372600000XNursing Service Related ProvidersAdult Companion
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant