Provider Demographics
NPI:1942032636
Name:PENA, DAYMI L
Entity type:Individual
Prefix:
First Name:DAYMI
Middle Name:L
Last Name:PENA
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 1:8400 49TH ST N APT 1015
Mailing Address - Street 2:
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33781-1546
Mailing Address - Country:US
Mailing Address - Phone:727-200-4121
Mailing Address - Fax:
Practice Address - Street 1:801 W BAY DR STE 405
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33770-3220
Practice Address - Country:US
Practice Address - Phone:786-479-8592
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-20
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician