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General NPI Number Information
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NPI Number | 1689195521
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Entity Type | Organization
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Legal Business Name | DANIEL DSTTEFFANO, MD & ASSOCIATES
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Dates
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Enumeration Date | 06/30/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 719 BENTON AVE
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City | BROOKSVILLE
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State | FL
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Zip | 34601-3213
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Country | US
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Telephone | 352-261-0107
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Fax | 352-559-8685
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Provider Business Mailing Address
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Address Line | 719 BENTON AVE
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City | BROOKSVILLE
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State | FL
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Zip | 34601-3213
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Country | US
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Telephone | 352-261-0107
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Fax | 352-559-8685
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Authorized Official
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Title or Position | OWNER
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Name | DANIEL DSTTEFFANO
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Credential | MD
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Telephone | 352-261-0107
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | ACN563
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 246ZE0600X
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Taxonomy Name | Electroneurodiagnostic Specialist/Technologist
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License Number | ACN563
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License Number State | FL
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