Provider Demographics
NPI:1235336744
Name:DANIEL, DENISE CORAL (MD, MPH)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:CORAL
Last Name:DANIEL
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:DENISE
Other - Middle Name:CORAL
Other - Last Name:SMYTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD, MPH
Mailing Address - Street 1:350 N CLYDE MORRIS BLVD
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114-2733
Mailing Address - Country:US
Mailing Address - Phone:386-238-3221
Mailing Address - Fax:386-238-3235
Practice Address - Street 1:350 N CLYDE MORRIS BLVD
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-2733
Practice Address - Country:US
Practice Address - Phone:386-238-3221
Practice Address - Fax:386-238-3235
Is Sole Proprietor?:No
Enumeration Date:2007-06-28
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV23331207P00000X, 207Q00000X
PAMD456007208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810013989Medicaid