Provider Demographics
NPI:1700187069
Name:WHITE, MYA DAPHNEE (AP)
Entity Type:Individual
Prefix:MS
First Name:MYA
Middle Name:DAPHNEE
Last Name:WHITE
Suffix:
Gender:F
Credentials:AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1298 NE 33RD ST
Mailing Address - Street 2:APT. A
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33334-4510
Mailing Address - Country:US
Mailing Address - Phone:561-702-5168
Mailing Address - Fax:
Practice Address - Street 1:1298 NE 33RD ST
Practice Address - Street 2:APT. A
Practice Address - City:OAKLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:33334-4510
Practice Address - Country:US
Practice Address - Phone:561-702-5168
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-03
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2907171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist