Healthcare Provider Details

I. General information

NPI: 1831020718
Provider Name (Legal Business Name): DANIELLE LOURDES ALEXIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1060 W STATE ROAD 434 STE 108
LONGWOOD FL
32750-4953
US

IV. Provider business mailing address

11829 JEFFERSON COMMONS CIR # 1231
ORLANDO FL
32826-2841
US

V. Phone/Fax

Practice location:
  • Phone: 561-685-8622
  • Fax:
Mailing address:
  • Phone: 561-685-8622
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberBACB1346336
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: