Provider Demographics
NPI:1770013526
Name:REGALADO, DANIELA LIZBETH
Entity Type:Individual
Prefix:
First Name:DANIELA
Middle Name:LIZBETH
Last Name:REGALADO
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 1:345 FORTUNE BLVD
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01757-1723
Mailing Address - Country:US
Mailing Address - Phone:508-473-3422
Mailing Address - Fax:508-634-8532
Practice Address - Street 1:214 COMMERCIAL ST STE 104
Practice Address - Street 2:
Practice Address - City:MALDEN
Practice Address - State:MA
Practice Address - Zip Code:02148-6712
Practice Address - Country:US
Practice Address - Phone:781-321-0645
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-14
Last Update Date:2017-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist