Healthcare Provider Details

I. General information

NPI: 1578484887
Provider Name (Legal Business Name): DAYANNA VANESSA DIAZ ACOSTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4670 NAVAHO CIR
ATLANTA GA
30349
US

IV. Provider business mailing address

4670 NAVAHO CIR
ATLANTA GA
30349
US

V. Phone/Fax

Practice location:
  • Phone: 347-432-0657
  • Fax:
Mailing address:
  • Phone: 347-432-0657
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number015950
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: