Provider Demographics
NPI:1346837887
Name:DANIELS, TROY
Entity Type:Individual
Prefix:MR
First Name:TROY
Middle Name:
Last Name:DANIELS
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 1:2553 MAYCREST ST NW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24012-3311
Mailing Address - Country:US
Mailing Address - Phone:540-314-1201
Mailing Address - Fax:
Practice Address - Street 1:2553 MAYCREST ST NW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24012-3311
Practice Address - Country:US
Practice Address - Phone:540-314-1201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-30
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health