Healthcare Provider Details

I. General information

NPI: 1609794163
Provider Name (Legal Business Name): DARRYL BEACHER MICKLE
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9114 37TH AVE
JACKSON HEIGHTS NY
11372-7920
US

IV. Provider business mailing address

3165 49TH ST APT 2D
WOODSIDE NY
11377-1318
US

V. Phone/Fax

Practice location:
  • Phone: 757-776-1767
  • Fax:
Mailing address:
  • Phone: 757-776-1757
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: