Healthcare Provider Details

I. General information

NPI: 1053766212
Provider Name (Legal Business Name): MICHELLE DIAZ NAZARIO LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELLE DEL CERRO

II. Dates (important events)

Enumeration Date: 04/25/2016
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5325 E STATE ROAD 64 STE B
BRADENTON FL
34208-5534
US

IV. Provider business mailing address

1411 HARNESS HORSE LN APT 302
BRANDON FL
33511-3847
US

V. Phone/Fax

Practice location:
  • Phone: 239-690-6906
  • Fax:
Mailing address:
  • Phone: 727-310-8599
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH23995
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: