MEDICARE: DANIEL FASSETT M.D., M.B.A.

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	207T00000X	Neurological Surgery Physician	ME154265	FL
2	207T00000X	Neurological Surgery Physician	036117618	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	036-117618	OTHER	IL	STATE LICENSE

General Provider Information

NPI Number	:	1205902442
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL FASSETT M.D., M.B.A.

Provider Business Mailing Address
First Line	:	265 E ROLLINS ST STE 11100
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32804-5570
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1141 PATTERSON TER
Second Line	:
City	:	LAKE MARY
State	:	FL
Zip	:	32746-2203
Country	:	US
Telephone Number	:	844-407-4070
Fax Number	:	407-743-3050

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

Provider Enumeration Date	:	11/28/2006
Last Update Date	:	01/12/2026

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