MEDICARE: DANIELLA LISSETTE LEAL PANDO

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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1376377036
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIELLA LISSETTE LEAL PANDO

Provider Business Mailing Address
First Line	:	777 NW 72ND AVE STE 1083
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33126-3176
Country	:	US
Telephone Number	:	305-342-7643
Fax Number	:

Provider Business Practice Location Address
First Line	:	6823 SW 130TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33183-2423
Country	:	US
Telephone Number	:	786-445-6500
Fax Number	:

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

Provider Enumeration Date	:	08/27/2024
Last Update Date	:	08/27/2024

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Directions to “ DANIELLA LISSETTE LEAL PANDO ” Practice Location

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