Healthcare Provider Details

I. General information

NPI: 1336093244
Provider Name (Legal Business Name): DANIEL KENNETH MACLEOD PMHNP; RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2026
Last Update Date: 02/26/2026
Certification Date: 02/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 GREAT QUARTER RD
SANDY HOOK CT
06482-1560
US

IV. Provider business mailing address

29 GREAT QUARTER RD
SANDY HOOK CT
06482-1560
US

V. Phone/Fax

Practice location:
  • Phone: 207-423-8846
  • Fax:
Mailing address:
  • Phone: 207-423-8846
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberF408113-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: