Provider Demographics
NPI:1497394530
Name:VALLADARES, DANIELLA FERNANDA (MA)
Entity Type:Individual
Prefix:MRS
First Name:DANIELLA
Middle Name:FERNANDA
Last Name:VALLADARES
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MS
Other - First Name:DANIELLA
Other - Middle Name:F
Other - Last Name:HERNANDEZ-PERILLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13421 SW 38TH LN
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-3217
Mailing Address - Country:US
Mailing Address - Phone:786-329-1516
Mailing Address - Fax:
Practice Address - Street 1:13421 SW 38TH LN
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-3217
Practice Address - Country:US
Practice Address - Phone:786-329-1516
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-06
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
FL1-22-62957103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0133002872OtherBOARD OF MEDICINE DEPARTMENT OF HEALTH PROFESSIONS IN VIRGINIA
FL105257900Medicaid