Healthcare Provider Details

I. General information

NPI: 1780912832
Provider Name (Legal Business Name): DANIEL J FANEUF HIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2009
Last Update Date: 11/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 LAFAYETTE RD SUITE 102
PORTSMOUTH NH
03801-5407
US

IV. Provider business mailing address

485 HIGH ST
HAMPTON NH
03842-2349
US

V. Phone/Fax

Practice location:
  • Phone: 603-319-1701
  • Fax: 603-319-1713
Mailing address:
  • Phone: 603-319-1701
  • Fax: 603-319-1713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberH584
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: