Healthcare Provider Details

I. General information

NPI: 1316862360
Provider Name (Legal Business Name): DAJA MCCREA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 HOLLYWOOD BLVD STE PHE
HOLLYWOOD FL
33021-6760
US

IV. Provider business mailing address

5250 FLETCHER ST
HOLLYWOOD FL
33021-8010
US

V. Phone/Fax

Practice location:
  • Phone: 954-822-4175
  • Fax:
Mailing address:
  • Phone: 754-707-2598
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-510750
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: