Provider Demographics
NPI:1720894116
Name:FELICIANO, DAYSHA BLISS
Entity type:Individual
Prefix:
First Name:DAYSHA
Middle Name:BLISS
Last Name:FELICIANO
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 1:1505 UNION ST
Mailing Address - Street 2:
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46544-5358
Mailing Address - Country:US
Mailing Address - Phone:574-292-9230
Mailing Address - Fax:
Practice Address - Street 1:2909 S MICHIGAN ST
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46614-1033
Practice Address - Country:US
Practice Address - Phone:574-329-6856
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-10
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician