Provider Demographics
NPI:1932371978
Name:DAISLEY, ADRIAN DAVID (BCBA)
Entity Type:Individual
Prefix:MR
First Name:ADRIAN
Middle Name:DAVID
Last Name:DAISLEY
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1531 PLANTATION POINTE DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32824-4855
Mailing Address - Country:US
Mailing Address - Phone:407-721-7755
Mailing Address - Fax:407-704-1144
Practice Address - Street 1:1531 PLANTATION POINTE DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32824-4855
Practice Address - Country:US
Practice Address - Phone:407-721-7755
Practice Address - Fax:407-704-1144
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-31
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL692682796103TB0200X
FL692682798103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL692682798Medicaid
FL692682796Medicaid