Healthcare Provider Details

I. General information

NPI: 1669979837
Provider Name (Legal Business Name): DANIEL STEPHEN DEMICK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2018
Last Update Date: 11/05/2025
Certification Date: 11/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 MACE RD
PATRICK AFB FL
32925-3616
US

IV. Provider business mailing address

105 KRISTI DR
INDIAN HARBOUR BEACH FL
32937-4106
US

V. Phone/Fax

Practice location:
  • Phone: 304-691-1500
  • Fax: 304-523-4358
Mailing address:
  • Phone: 740-649-6147
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberD0104452
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME170501
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: