Healthcare Provider Details

I. General information

NPI: 1699427294
Provider Name (Legal Business Name): DAYLEN MEDAL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2022
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12995 S CLEVELAND AVE STE 216
FORT MYERS FL
33907-3807
US

IV. Provider business mailing address

601 SE 13TH TER
CAPE CORAL FL
33990-2194
US

V. Phone/Fax

Practice location:
  • Phone: 305-389-3224
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-21-192895
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: