Healthcare Provider Details

I. General information

NPI: 1194638858
Provider Name (Legal Business Name): DAISY IVONNE MCCLOUD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1007 QUENTIN RD
BROOKLYN NY
11223-2341
US

IV. Provider business mailing address

1007 QUENTIN RD
BROOKLYN NY
11223-2341
US

V. Phone/Fax

Practice location:
  • Phone: 718-998-3235
  • Fax: 718-336-3040
Mailing address:
  • Phone: 718-998-3235
  • Fax: 718-336-3040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number172103550
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: