Healthcare Provider Details

I. General information

NPI: 1699604298
Provider Name (Legal Business Name): DALASIA LENZIE GRADDICK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

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

350 FAIRWAY DR STE 101
DEERFIELD BEACH FL
33441-1834
US

IV. Provider business mailing address

537 NW 46TH AVE # 537
DELRAY BEACH FL
33445-2114
US

V. Phone/Fax

Practice location:
  • Phone: 888-880-9270
  • Fax: 888-880-9270
Mailing address:
  • Phone: 785-854-3577
  • Fax: 785-854-3577

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: