Provider Demographics
NPI:1609761493
Name:MANOTAS DIAZ, SHAID
Entity type:Individual
Prefix:
First Name:SHAID
Middle Name:
Last Name:MANOTAS DIAZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 TROPICANA PKWY E
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33909-1965
Mailing Address - Country:US
Mailing Address - Phone:786-362-0638
Mailing Address - Fax:
Practice Address - Street 1:117 TROPICANA PKWY E
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33909-1965
Practice Address - Country:US
Practice Address - Phone:786-362-0638
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-11
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-25-443676106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician