Healthcare Provider Details

I. General information

NPI: 1588583868
Provider Name (Legal Business Name): DAIQUANA CHANELL RHODY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

575 FOWLER AVE
PELHAM NY
10803-2521
US

IV. Provider business mailing address

575 FOWLER AVE
PELHAM NY
10803-2521
US

V. Phone/Fax

Practice location:
  • Phone: 914-336-9500
  • Fax:
Mailing address:
  • Phone: 914-336-9500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: