Provider Demographics
NPI:1528618253
Name:LOPEZ MACHANDI, DAYANNA
Entity type:Individual
Prefix:
First Name:DAYANNA
Middle Name:
Last Name:LOPEZ MACHANDI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12966 SW 133RD CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-6173
Mailing Address - Country:US
Mailing Address - Phone:305-255-6203
Mailing Address - Fax:
Practice Address - Street 1:15599 SW 106TH LN APT 1208
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33196-3504
Practice Address - Country:US
Practice Address - Phone:702-888-5480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-15
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT-18-60677106S00000X
FL1-21-49442103K00000X
FL0-19-10687106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL022017000Medicaid