Provider Demographics
NPI:1912578634
Name:MATADIN, DAISY LYNN
Entity Type:Individual
Prefix:
First Name:DAISY
Middle Name:LYNN
Last Name:MATADIN
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 1:923 PARK MANOR DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32825-6740
Mailing Address - Country:US
Mailing Address - Phone:407-914-5485
Mailing Address - Fax:
Practice Address - Street 1:923 PARK MANOR DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32825-6740
Practice Address - Country:US
Practice Address - Phone:407-914-5485
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-03
Last Update Date:2021-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health