Healthcare Provider Details

I. General information

NPI: 1659138097
Provider Name (Legal Business Name): DAINERYS CANCIO MURSULI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2024
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1235 S 21ST AVE APT 111
HOLLYWOOD FL
33020-6969
US

IV. Provider business mailing address

2050 SW 122ND AVE APT 23
MIAMI FL
33175-7371
US

V. Phone/Fax

Practice location:
  • Phone: 786-451-5535
  • Fax:
Mailing address:
  • Phone: 786-451-5535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-24-326027
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: