MEDICARE: FULANI DANIEL

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	124Q00000X	Dental Hygienist	DH24214	FL

General Provider Information

NPI Number	:	1447759485
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FULANI DANIEL

Provider Business Mailing Address
First Line	:	3413 S KINGS AVE STE 200
Second Line	:
City	:	BRANDON
State	:	FL
Zip	:	33511-7780
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3413 S KINGS AVE STE 200
Second Line	:
City	:	BRANDON
State	:	FL
Zip	:	33511-7780
Country	:	US
Telephone Number	:	813-643-9029
Fax Number	:

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

Provider Enumeration Date	:	02/05/2018
Last Update Date	:	04/03/2018

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Directions to “ FULANI DANIEL ” Practice Location

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