Healthcare Provider Details

I. General information

NPI: 1780452219
Provider Name (Legal Business Name): DAISYMAE COYNE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2023
Last Update Date: 12/14/2023
Certification Date: 12/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 ASCEND LOOP UNIT 6205
MYRTLE BEACH SC
29579-2827
US

IV. Provider business mailing address

320 ASCEND LOOP UNIT 6205
MYRTLE BEACH SC
29579-2827
US

V. Phone/Fax

Practice location:
  • Phone: 908-309-8266
  • Fax:
Mailing address:
  • Phone: 908-309-8266
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: