Healthcare Provider Details

I. General information

NPI: 1972432680
Provider Name (Legal Business Name): WELLNESSCONNECTIONFL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8804 LAKE PARK CIR S
DAVIE FL
33328-7013
US

IV. Provider business mailing address

8804 LAKE PARK CIR S
DAVIE FL
33328-7013
US

V. Phone/Fax

Practice location:
  • Phone: 754-400-1382
  • Fax:
Mailing address:
  • Phone: 754-400-1382
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: DAILEN NAIROBYS DIAZ MACHADO
Title or Position: MENTAL HEALTH THERAPIST
Credential: LCSW
Phone: 786-828-9644