MEDICARE: MAIDELY DIAZ MACHADO

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		FL

General Provider Information

NPI Number	:	1851256598
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAIDELY DIAZ MACHADO

Provider Business Mailing Address
First Line	:	897 SW CURRY ST
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34983-1903
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1631 NW SAINT LUCIE WEST BLVD STE 201
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34986-1963
Country	:	US
Telephone Number	:	772-237-1731
Fax Number	:

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

Provider Enumeration Date	:	12/16/2025
Last Update Date	:	12/16/2025

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