MEDICARE: MR. ADRIAN DAVID DAISLEY BCBA

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	103TB0200X	Cognitive & Behavioral Psychologist	692682796	FL
2	103TB0200X	Cognitive & Behavioral Psychologist	692682798	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	:	1932371978
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ADRIAN DAVID DAISLEY BCBA

Provider Business Mailing Address
First Line	:	1531 PLANTATION POINTE DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32824-4855
Country	:	US
Telephone Number	:	407-721-7755
Fax Number	:	407-704-1144

Provider Business Practice Location Address
First Line	:	1531 PLANTATION POINTE DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32824-4855
Country	:	US
Telephone Number	:	407-721-7755
Fax Number	:	407-704-1144

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

Provider Enumeration Date	:	03/31/2008
Last Update Date	:	05/31/2016

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