Healthcare Provider Details

I. General information

NPI: 1174452502
Provider Name (Legal Business Name): DME ACADEMY WISCONSIN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2441 BELLEVUE AVE
DAYTONA BEACH FL
32114-5615
US

IV. Provider business mailing address

2441 BELLEVUE AVE
DAYTONA BEACH FL
32114-5615
US

V. Phone/Fax

Practice location:
  • Phone: 445-200-3669
  • Fax:
Mailing address:
  • Phone: 445-200-3669
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DANIEL PANAGGIO
Title or Position: MGR
Credential:
Phone: 445-200-3669