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General NPI Number Information
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NPI Number | 1497121321
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Entity Type | Individual
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Provider Name | DANYALE RENEE MCLEAN
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Gender | Female
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Dates
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Enumeration Date | 08/14/2015
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Last Update Date | 03/10/2021
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Provider Practice Location Address
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Address Line | 1814 WELLNESS LN
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City | NEW PORT RICHEY
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State | FL
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Zip | 34655-5357
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Country | US
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Telephone | 813-450-8989
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Fax |
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Provider Business Mailing Address
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Address Line | 5118 BELLE CHASE CIR
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City | TAMPA
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State | FL
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Zip | 33634-4253
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Country | US
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Telephone | 937-479-1904
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AL4885
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License Number State | FL
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