Provider Demographics
NPI:1750184305
Name:CANDELARIO, MIKAELA DANIELLE (PA-C)
Entity type:Individual
Prefix:
First Name:MIKAELA
Middle Name:DANIELLE
Last Name:CANDELARIO
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 S HARDIN BLVD
Mailing Address - Street 2:STE 110 PMB 130
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-7702
Mailing Address - Country:US
Mailing Address - Phone:972-762-4642
Mailing Address - Fax:
Practice Address - Street 1:5375 COIT RD STE 130
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035-4914
Practice Address - Country:US
Practice Address - Phone:214-619-1910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-29
Last Update Date:2025-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA189962084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology