Provider Demographics
NPI:1548266059
Name:FARDALES, DAYSI
Entity type:Individual
Prefix:
First Name:DAYSI
Middle Name:
Last Name:FARDALES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DAYSI
Other - Middle Name:
Other - Last Name:FARDALES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:400 N HIATUS RD STE 105
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33026-5214
Mailing Address - Country:US
Mailing Address - Phone:954-431-8000
Mailing Address - Fax:954-436-0449
Practice Address - Street 1:1100 NW 95TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33150-2038
Practice Address - Country:US
Practice Address - Phone:305-835-6191
Practice Address - Fax:305-694-3649
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-21
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2523162363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL304361400Medicaid