Provider Demographics
NPI:1770107096
Name:DANIELS, DAQUESHA VICHELLE
Entity type:Individual
Prefix:
First Name:DAQUESHA
Middle Name:VICHELLE
Last Name:DANIELS
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 1:1111 W MOCKINGBIRD LN STE 1030
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75247-5028
Mailing Address - Country:US
Mailing Address - Phone:469-730-3284
Mailing Address - Fax:
Practice Address - Street 1:1111 W MOCKINGBIRD LN STE 1030
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75247-5028
Practice Address - Country:US
Practice Address - Phone:469-730-3284
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-02
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator