MEDICARE: DANIELYS PENA CHANG

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	222Q00000X	Developmental Therapist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	21193624	OTHER	FL	RBT CERTIFICATION

General Provider Information

NPI Number	:	1457011033
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIELYS PENA CHANG

Provider Business Mailing Address
First Line	:	3630 TERRAPIN LN APT 711
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33067-3164
Country	:	US
Telephone Number	:	510-290-6960
Fax Number	:

Provider Business Practice Location Address
First Line	:	3630 TERRAPIN LN APT 711
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33067-3164
Country	:	US
Telephone Number	:	510-290-6960
Fax Number	:

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

Provider Enumeration Date	:	12/23/2021
Last Update Date	:	12/23/2021

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Directions to “ DANIELYS PENA CHANG ” Practice Location

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