Healthcare Provider Details

I. General information

NPI: 1639613391
Provider Name (Legal Business Name): DAYANA TIMA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2016
Last Update Date: 05/04/2022
Certification Date: 05/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13650 NW 8TH ST STE 109
SUNRISE FL
33325-6239
US

IV. Provider business mailing address

2851 W PROSPECT RD 301
TAMARAC FLORIDA
33309
UM

V. Phone/Fax

Practice location:
  • Phone: 866-965-3262
  • Fax:
Mailing address:
  • Phone: 561-252-4016
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code247200000X
TaxonomyOther Technician
License Number112016DATI
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: