Healthcare Provider Details

I. General information

NPI: 1720616840
Provider Name (Legal Business Name): LAUREN DANEMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAUREN WALTER

II. Dates (important events)

Enumeration Date: 04/01/2020
Last Update Date: 12/07/2025
Certification Date: 12/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3515 E FLETCHER AVE # MDC014
TAMPA FL
33613-4706
US

IV. Provider business mailing address

PO BOX 917770
ORLANDO FL
32891-7770
US

V. Phone/Fax

Practice location:
  • Phone: 813-821-8032
  • Fax:
Mailing address:
  • Phone: 813-821-8038
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberME167722
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: