MEDICARE: KERRI DANIELS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	E-5922	AR
2	208000000X	Pediatrics Physician	ME108559	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134348469
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KERRI DANIELS MD

Provider Business Mailing Address
First Line	:	5827 CORPORATE WAY
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33407-2000
Country	:	US
Telephone Number	:	561-844-9443
Fax Number	:	561-844-1013

Provider Business Practice Location Address
First Line	:	3235 SW PORT ST LUCIE BLVD STE 105
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34953-3405
Country	:	US
Telephone Number	:	772-408-5063
Fax Number	:	844-540-4793

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/25/2007
Last Update Date	:	03/18/2019

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Directions to “ KERRI DANIELS MD” Practice Location

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