MEDICARE: DAYLEANN M VALLEJO MA

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	225700000X	Massage Therapist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MA 50721	OTHER	FL	MASSAGE THERAPIST

General Provider Information

NPI Number	:	1700196102
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAYLEANN M VALLEJO MA

Provider Business Mailing Address
First Line	:	672 N SEMORAN BLVD
Second Line	:	STE 304
City	:	ORLANDO
State	:	FL
Zip	:	32807-3350
Country	:	US
Telephone Number	:	407-275-7767
Fax Number	:	407-275-7787

Provider Business Practice Location Address
First Line	:	672 N SEMORAN BLVD
Second Line	:	STE 304
City	:	ORLANDO
State	:	FL
Zip	:	32807-3350
Country	:	US
Telephone Number	:	407-275-7767
Fax Number	:	407-275-7787

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

Provider Enumeration Date	:	10/19/2010
Last Update Date	:	10/19/2010

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Directions to “ DAYLEANN M VALLEJO MA” Practice Location

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