Provider Demographics
NPI:1649503145
Name:MENDEZ, DANIELLE LEE KVIDERA (LMP, MMP)
Entity type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:LEE KVIDERA
Last Name:MENDEZ
Suffix:
Gender:F
Credentials:LMP, MMP
Other - Prefix:MISS
Other - First Name:DANIELLE
Other - Middle Name:LEE
Other - Last Name:KVIDERA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP
Mailing Address - Street 1:5843 RAMSEY ST
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28311-3467
Mailing Address - Country:US
Mailing Address - Phone:910-818-2513
Mailing Address - Fax:
Practice Address - Street 1:642 KENTUCKY DERBY LN
Practice Address - Street 2:
Practice Address - City:LILLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27546-9742
Practice Address - Country:US
Practice Address - Phone:541-218-0584
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-15
Last Update Date:2019-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14605225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist