Provider Demographics
NPI:1699250340
Name:DALEY, RASHAYNE E
Entity type:Individual
Prefix:
First Name:RASHAYNE
Middle Name:E
Last Name:DALEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1410 SUMMIT PINES BLVD APT 921
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33415-5104
Mailing Address - Country:US
Mailing Address - Phone:516-406-7455
Mailing Address - Fax:
Practice Address - Street 1:123 NW 13TH ST STE 305B
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33432-1645
Practice Address - Country:US
Practice Address - Phone:786-230-6591
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-28
Last Update Date:2018-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL687031106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL687031Medicaid