Provider Demographics
NPI:1124401138
Name:SPIDALIERI, DANNY
Entity Type:Individual
Prefix:MR
First Name:DANNY
Middle Name:
Last Name:SPIDALIERI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:932 N DIXIE HWY
Mailing Address - Street 2:UNIT 2
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33460-2573
Mailing Address - Country:US
Mailing Address - Phone:561-308-3570
Mailing Address - Fax:
Practice Address - Street 1:932 N DIXIE HWY
Practice Address - Street 2:UNIT 2
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33460-2573
Practice Address - Country:US
Practice Address - Phone:561-308-3570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-08
Last Update Date:2015-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL15-0036129332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL013391800Medicaid