Healthcare Provider Details

I. General information

NPI: 1912346123
Provider Name (Legal Business Name): DANIEL ANTHONY PIETRAS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2013
Last Update Date: 01/09/2025
Certification Date: 01/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2151 45TH ST STE 210
WEST PALM BEACH FL
33407-2015
US

IV. Provider business mailing address

308 NW 5TH AVE
OKEECHOBEE FL
34972-2568
US

V. Phone/Fax

Practice location:
  • Phone: 863-261-8354
  • Fax: 863-638-5637
Mailing address:
  • Phone: 632-618-3548
  • Fax: 863-824-7511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number01080903A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME128495
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: