Healthcare Provider Details

I. General information

NPI: 1295161099
Provider Name (Legal Business Name): DANIEL E. VERDINE PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2013
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 E DIXIE AVE
LEESBURG FL
34748-5925
US

IV. Provider business mailing address

1425 PORTLAND AVE
ROCHESTER NY
14621-3001
US

V. Phone/Fax

Practice location:
  • Phone: 352-787-9838
  • Fax: 352-787-8705
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number017016
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMV0900111
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: