Provider Demographics
NPI:1881308757
Name:DANIELS, COTY M
Entity type:Individual
Prefix:MR
First Name:COTY
Middle Name:M
Last Name:DANIELS
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 1:320 VENICE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROYAL PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-4318
Mailing Address - Country:US
Mailing Address - Phone:954-993-9978
Mailing Address - Fax:
Practice Address - Street 1:320 VENICE BLVD
Practice Address - Street 2:
Practice Address - City:ROYAL PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411-4318
Practice Address - Country:US
Practice Address - Phone:954-993-9978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-05
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9940999311ZA0620X
FLRN9440999376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home