Healthcare Provider Details

I. General information

NPI: 1154014108
Provider Name (Legal Business Name): CARISSA DANELSKI O'DAY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2023
Last Update Date: 05/26/2023
Certification Date: 05/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARIDAD CENTER 8645 BOYNTON BEACH BLVD
BOYNTON BEACH FL
33472
US

IV. Provider business mailing address

429 NE SPANISH CT
BOCA RATON FL
33432-4129
US

V. Phone/Fax

Practice location:
  • Phone: 561-737-6336
  • Fax:
Mailing address:
  • Phone: 561-654-3533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9101125
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: