Provider Demographics
NPI:1790457166
Name:REYES PEREZ, DANIELA MICHELLE
Entity Type:Individual
Prefix:
First Name:DANIELA
Middle Name:MICHELLE
Last Name:REYES PEREZ
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 1:3357 W VINE ST STE 103
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-4664
Mailing Address - Country:US
Mailing Address - Phone:407-201-6255
Mailing Address - Fax:407-201-7195
Practice Address - Street 1:3357 W VINE ST STE 103
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-4664
Practice Address - Country:US
Practice Address - Phone:407-201-6255
Practice Address - Fax:407-201-7195
Is Sole Proprietor?:No
Enumeration Date:2021-10-04
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician