MEDICARE: DAYSI FARDALES

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	363L00000X	Nurse Practitioner	ARNP2523162	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548266059
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAYSI FARDALES

Provider Business Mailing Address
First Line	:	400 N HIATUS RD STE 105
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33026-5214
Country	:	US
Telephone Number	:	954-431-8000
Fax Number	:	954-436-0449

Provider Business Practice Location Address
First Line	:	5200 SW 166TH AVE
Second Line	:
City	:	SOUTHWEST RANCHES
State	:	FL
Zip	:	33331-1307
Country	:	US
Telephone Number	:	954-540-1627
Fax Number	:	305-280-8261

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

Provider Enumeration Date	:	06/21/2005
Last Update Date	:	08/11/2025

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Directions to “ DAYSI FARDALES ” Practice Location

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