Provider Demographics
NPI:1710739578
Name:ESTADES QUIROS, DAYLISSE JENIREE
Entity Type:Individual
Prefix:
First Name:DAYLISSE
Middle Name:JENIREE
Last Name:ESTADES QUIROS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:722 LEGENDS CLUB DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29466-9052
Mailing Address - Country:US
Mailing Address - Phone:787-237-2937
Mailing Address - Fax:
Practice Address - Street 1:722 LEGENDS CLUB DR
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29466-9052
Practice Address - Country:US
Practice Address - Phone:787-237-2937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-04
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC320174103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool