Provider Demographics
NPI:1871229278
Name:FREDERICK, DARRYKA LYNETTE
Entity type:Individual
Prefix:
First Name:DARRYKA
Middle Name:LYNETTE
Last Name:FREDERICK
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 1:11130 SW 154TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33157-1245
Mailing Address - Country:US
Mailing Address - Phone:786-657-6886
Mailing Address - Fax:
Practice Address - Street 1:11130 SW 154TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33157-1245
Practice Address - Country:US
Practice Address - Phone:786-657-6886
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-27
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program