Healthcare Provider Details

I. General information

NPI: 1669131256
Provider Name (Legal Business Name): DAILANYS CUELLAR CARVAJAL RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2021
Last Update Date: 12/11/2021
Certification Date: 12/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4866 KIRK RD
LAKE WORTH FL
33461-5327
US

IV. Provider business mailing address

4866 KIRK RD
LAKE WORTH FL
33461-5327
US

V. Phone/Fax

Practice location:
  • Phone: 561-386-3316
  • Fax:
Mailing address:
  • Phone: 561-386-3316
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-21-156882
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: