MEDICARE: MS. ALICIA A DANIELS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207QA0505X	Adult Medicine Physician	11024593	FL
2	207QG0300X	Geriatric Medicine (Family Medicine) Physician	11024593	FL

General Provider Information

NPI Number	:	1073201828
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ALICIA A DANIELS

Provider Business Mailing Address
First Line	:	3211 NW 191ST ST
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33056-3040
Country	:	US
Telephone Number	:	786-955-7216
Fax Number	:

Provider Business Practice Location Address
First Line	:	3211 NW 191ST ST
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33056-3040
Country	:	US
Telephone Number	:	786-955-7216
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/28/2023
Last Update Date	:	04/28/2023

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Directions to “ MS. ALICIA A DANIELS ” Practice Location

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