MEDICARE: DANYALE RENEE MCLEAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	2255A2300X	Athletic Trainer	AL4885	FL

General Provider Information

NPI Number	:	1497121321
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANYALE RENEE MCLEAN

Provider Business Mailing Address
First Line	:	5118 BELLE CHASE CIR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33634-4253
Country	:	US
Telephone Number	:	937-479-1904
Fax Number	:

Provider Business Practice Location Address
First Line	:	1814 WELLNESS LN
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34655-5357
Country	:	US
Telephone Number	:	813-450-8989
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/14/2015
Last Update Date	:	03/10/2021

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