Healthcare Provider Details

I. General information

NPI: 1427462167
Provider Name (Legal Business Name): DANIEL ELLIOT NASSAU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2014
Last Update Date: 05/04/2022
Certification Date: 05/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 SW 60TH CT STE 104
MIAMI FL
33155-4069
US

IV. Provider business mailing address

3200 SW 60TH CT STE 104
MIAMI FL
33155-4069
US

V. Phone/Fax

Practice location:
  • Phone: 305-669-6448
  • Fax: 305-663-8485
Mailing address:
  • Phone: 305-669-6448
  • Fax: 305-663-8485

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberME144710
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2088P0231X
TaxonomyPediatric Urology Physician
License NumberME144710
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: