Healthcare Provider Details

I. General information

NPI: 1003664434
Provider Name (Legal Business Name): DANIEL WEITZNER PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2024
Last Update Date: 10/14/2024
Certification Date: 10/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 MORTON PLANT ST STE 401
CLEARWATER FL
33756-3394
US

IV. Provider business mailing address

2995 DREW ST FL 2
CLEARWATER FL
33759-3012
US

V. Phone/Fax

Practice location:
  • Phone: 727-298-6025
  • Fax: 727-333-6038
Mailing address:
  • Phone: 727-315-7496
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPY12185
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: