Provider Demographics
NPI:1700196102
Name:VALLEJO, DAYLEANN M (MA)
Entity Type:Individual
Prefix:
First Name:DAYLEANN
Middle Name:M
Last Name:VALLEJO
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:672 N SEMORAN BLVD
Mailing Address - Street 2:STE 304
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32807-3350
Mailing Address - Country:US
Mailing Address - Phone:407-275-7767
Mailing Address - Fax:407-275-7787
Practice Address - Street 1:672 N SEMORAN BLVD
Practice Address - Street 2:STE 304
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32807-3350
Practice Address - Country:US
Practice Address - Phone:407-275-7767
Practice Address - Fax:407-275-7787
Is Sole Proprietor?:No
Enumeration Date:2010-10-19
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMA 50721OtherMASSAGE THERAPIST