Provider Demographics
NPI:1184029381
Name:PROFILO, DANIELE (MS)
Entity Type:Individual
Prefix:
First Name:DANIELE
Middle Name:
Last Name:PROFILO
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3602 DATA DR APT 304
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-2792
Mailing Address - Country:US
Mailing Address - Phone:515-708-5948
Mailing Address - Fax:
Practice Address - Street 1:3602 DATA DR APT 304
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-2792
Practice Address - Country:US
Practice Address - Phone:515-708-5948
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-30
Last Update Date:2014-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program