Provider Demographics
NPI:1750905725
Name:PEREIRA, DAYLAN
Entity type:Individual
Prefix:
First Name:DAYLAN
Middle Name:
Last Name:PEREIRA
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 1:4721 NW 7TH ST APT 110
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-2278
Mailing Address - Country:US
Mailing Address - Phone:954-629-4416
Mailing Address - Fax:
Practice Address - Street 1:4721 NW 7TH ST APT 110
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-2278
Practice Address - Country:US
Practice Address - Phone:954-629-4416
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-04
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL20120095106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician