Provider Demographics
NPI:1326794314
Name:SCANTLEBURY, DANIELA MARIE (DC)
Entity Type:Individual
Prefix:
First Name:DANIELA
Middle Name:MARIE
Last Name:SCANTLEBURY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18361 BRIDLE CLUB DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-1783
Mailing Address - Country:US
Mailing Address - Phone:321-960-3890
Mailing Address - Fax:
Practice Address - Street 1:2948 PROVIDENCE LAKES BLVD UNIT 5
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-2745
Practice Address - Country:US
Practice Address - Phone:813-437-9907
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-28
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL13734111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor