Healthcare Provider Details

I. General information

NPI: 1518526979
Provider Name (Legal Business Name): DANIELLESHERRI WANDA BAKER 171M00000X
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2019
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 W GRANADA BLVD STE A11
ORMOND BEACH FL
32174-9488
US

IV. Provider business mailing address

816 DONNELLY PL
DAYTONA BEACH FL
32114-5506
US

V. Phone/Fax

Practice location:
  • Phone: 916-796-2823
  • Fax:
Mailing address:
  • Phone: 916-796-2823
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-26-17150
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: