Provider Demographics
NPI:1295579621
Name:DANIEL, MYANNA I
Entity type:Individual
Prefix:
First Name:MYANNA
Middle Name:I
Last Name:DANIEL
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 1:565 SW DAHLED AVE
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-4029
Mailing Address - Country:US
Mailing Address - Phone:305-850-5901
Mailing Address - Fax:
Practice Address - Street 1:2331 HANSEN CT
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32301-4859
Practice Address - Country:US
Practice Address - Phone:850-320-6555
Practice Address - Fax:888-873-4610
Is Sole Proprietor?:No
Enumeration Date:2024-06-20
Last Update Date:2025-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program