MEDICARE: MISS DAHIFNA DANIEL M.S.

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	235Z00000X	Speech-Language Pathologist	PCET002335	GA

General Provider Information

NPI Number	:	1720512262
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS DAHIFNA DANIEL M.S.

Provider Business Mailing Address
First Line	:	4705 W VILLAGE WAY SE
Second Line	:	APT. #2520
City	:	SMYRNA
State	:	GA
Zip	:	30080-9320
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2385 LAWRENCEVILLE HWY
Second Line	:	STE. B
City	:	DECATUR
State	:	GA
Zip	:	30033-3168
Country	:	US
Telephone Number	:	404-289-4270
Fax Number	:

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

Provider Enumeration Date	:	04/11/2017
Last Update Date	:	04/11/2017

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Directions to “ MISS DAHIFNA DANIEL M.S.” Practice Location

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