Provider Demographics
NPI:1427784198
Name:MERCHAN, MAURIHERKA DANIELA (SA-C)
Entity type:Individual
Prefix:
First Name:MAURIHERKA
Middle Name:DANIELA
Last Name:MERCHAN
Suffix:
Gender:F
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 STATE ROAD 44 UNIT 1241
Mailing Address - Street 2:
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32168-8219
Mailing Address - Country:US
Mailing Address - Phone:701-580-6415
Mailing Address - Fax:
Practice Address - Street 1:2500 STATE ROAD 44 UNIT 1241
Practice Address - Street 2:
Practice Address - City:NEW SMYRNA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32168-8219
Practice Address - Country:US
Practice Address - Phone:701-580-6415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-26
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI21-127246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant