MEDICARE: DANIEL STUDDARD

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	104100000X	Social Worker

General Provider Information

NPI Number	:	1508244781
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL STUDDARD

Provider Business Mailing Address
First Line	:	6100 BLUE LAGOON DR
Second Line	:	SUITE 400
City	:	MIAMI
State	:	FL
Zip	:	33126-2079
Country	:	US
Telephone Number	:	305-398-6100
Fax Number	:

Provider Business Practice Location Address
First Line	:	1061 W OAKLAND PARK BLVD
Second Line	:
City	:	WILTON MANORS
State	:	FL
Zip	:	33311-1609
Country	:	US
Telephone Number	:	954-580-0770
Fax Number	:

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

Provider Enumeration Date	:	05/08/2015
Last Update Date	:	05/08/2015

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Directions to “ DANIEL STUDDARD ” Practice Location

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