Provider Demographics
NPI:1730881913
Name:PHARAUD, DANIELSON
Entity type:Individual
Prefix:
First Name:DANIELSON
Middle Name:
Last Name:PHARAUD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 CYPRESS TRCE
Mailing Address - Street 2:
Mailing Address - City:ROYAL PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-4956
Mailing Address - Country:US
Mailing Address - Phone:561-436-3480
Mailing Address - Fax:
Practice Address - Street 1:7711 N MILITARY TRL STE 205
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33410-6506
Practice Address - Country:US
Practice Address - Phone:954-408-7313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-20
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician