Provider Demographics
NPI:1710497326
Name:HALL, DAYLAN FREDRICK
Entity Type:Individual
Prefix:
First Name:DAYLAN
Middle Name:FREDRICK
Last Name:HALL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 NE 200TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33179-5138
Mailing Address - Country:US
Mailing Address - Phone:305-785-4864
Mailing Address - Fax:
Practice Address - Street 1:1320 NE 200TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33179-5138
Practice Address - Country:US
Practice Address - Phone:305-785-4864
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-10
Last Update Date:2017-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL687028Medicaid
FL687028OtherAPPLICATION TRACKING NUMBER