Healthcare Provider Details

I. General information

NPI: 1659012151
Provider Name (Legal Business Name): DANAY BAEZ FUENTES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2022
Last Update Date: 05/23/2026
Certification Date: 05/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3175 S CONGRESS AVE STE 103
PALM SPRINGS FL
33461-2502
US

IV. Provider business mailing address

2062 SE CROWBERRY DR
PORT ST LUCIE FL
34983-4675
US

V. Phone/Fax

Practice location:
  • Phone: 561-729-6631
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-24-73867
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: