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210 S Beach St Ste 200 Daytona Beach FL 32114-4433 | |
| (386) 898-6040 | |
| (386) 256-2320 |
| Full Name | |
|---|---|
| Speciality | Speech-language Pathologist |
| Location | 210 S Beach St Ste 200, Daytona Beach, Florida |
| Authorized Official Name and Position | Maika Fernandez-wallace (PROGRAM DIRECTOR) |
| Authorized Official Contact | 3868986040 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
210 S Beach St Ste 200 Daytona Beach FL 32114-4433 Ph: (386) 898-6040 | 210 S Beach St Ste 200 Daytona Beach FL 32114-4433 Ph: (386) 898-6040 |
| NPI Number | 1649622358 |
|---|---|
| Provider Enumeration Date | 07/06/2016 |
| Last Update Date | 09/16/2024 |
| Certification Date | 09/16/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649622358 | NPI | - | NPPES |
| 019212700 | Medicaid | FL | |
| 019647200 | Medicaid | FL |
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