Provider Demographics
NPI:1396351979
Name:DE MEDEIROS, DANIELA OLIVEIRA (PSYD, MSED, MS)
Entity type:Individual
Prefix:DR
First Name:DANIELA
Middle Name:OLIVEIRA
Last Name:DE MEDEIROS
Suffix:
Gender:F
Credentials:PSYD, MSED, MS
Other - Prefix:DR
Other - First Name:DANIELA
Other - Middle Name:
Other - Last Name:OLIVEIRA DE MEDEIROS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:55 SW 9TH ST APT 3306
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33130-4511
Mailing Address - Country:US
Mailing Address - Phone:305-904-0370
Mailing Address - Fax:
Practice Address - Street 1:111 MAJORCA AVE # B
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-4508
Practice Address - Country:US
Practice Address - Phone:305-448-8325
Practice Address - Fax:305-448-0687
Is Sole Proprietor?:No
Enumeration Date:2020-09-19
Last Update Date:2020-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY10790103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical