Provider Demographics
NPI:1053021642
Name:PORTNOY, DANIELA (MA)
Entity type:Individual
Prefix:
First Name:DANIELA
Middle Name:
Last Name:PORTNOY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21543 CORONADO AVE
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-7538
Mailing Address - Country:US
Mailing Address - Phone:103-422-9390
Mailing Address - Fax:
Practice Address - Street 1:21100 RUTH AND BARON COLEMAN BLVD
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33428-1714
Practice Address - Country:US
Practice Address - Phone:561-852-5099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-05
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ10939235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty