MEDICARE: DR. DANIEL MANESH DNP, FNP-C, PMHNP-BC

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	163W00000X	Registered Nurse	861682	TX
2	363LF0000X	Family Nurse Practitioner	1031933	TX
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	1031933	TX

General Provider Information

NPI Number	:	1780283234
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANIEL MANESH DNP, FNP-C, PMHNP-BC

Provider Business Mailing Address
First Line	:	9414 PEGASUS RUN RD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78254-6216
Country	:	US
Telephone Number	:	210-957-9382
Fax Number	:

Provider Business Practice Location Address
First Line	:	915 S LAREDO ST
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78204-3211
Country	:	US
Telephone Number	:	210-277-1418
Fax Number	:	210-277-1458

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

Provider Enumeration Date	:	10/25/2020
Last Update Date	:	11/13/2024

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