Provider Demographics
NPI:1891578498
Name:MENDOZA, DAYANA (BACB559118)
Entity Type:Individual
Prefix:
First Name:DAYANA
Middle Name:
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:BACB559118
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1409 YELLOW FINCH DR
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33837-8850
Mailing Address - Country:US
Mailing Address - Phone:786-675-0882
Mailing Address - Fax:
Practice Address - Street 1:1409 YELLOW FINCH DR
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33837-8850
Practice Address - Country:US
Practice Address - Phone:786-675-0882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-16
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRBT-23-290623106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician