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General NPI Number Information
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NPI Number | 1720894116
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Entity Type | Individual
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Provider Name | DAYSHA BLISS FELICIANO
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Gender | Female
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Dates
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Enumeration Date | 12/10/2024
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Last Update Date | 12/10/2024
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Provider Practice Location Address
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Address Line | 2909 S MICHIGAN ST
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City | SOUTH BEND
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State | IN
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Zip | 46614-1033
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Country | US
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Telephone | 574-329-6856
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Fax |
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Provider Business Mailing Address
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Address Line | 1505 UNION ST
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City | MISHAWAKA
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State | IN
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Zip | 46544-5358
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Country | US
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Telephone | 574-292-9230
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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