Provider Demographics
NPI:1558328740
Name:LELI, DANO ANTHONY (PHD)
Entity Type:Individual
Prefix:DR
First Name:DANO
Middle Name:ANTHONY
Last Name:LELI
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 947617
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32794-7617
Mailing Address - Country:US
Mailing Address - Phone:407-628-5354
Mailing Address - Fax:407-628-0254
Practice Address - Street 1:500 N. MAITLAND AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751
Practice Address - Country:US
Practice Address - Phone:407-628-5354
Practice Address - Fax:407-628-0254
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-01
Last Update Date:2010-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY003919103G00000X
FLPY3919103G00000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
73317XMedicare PIN
73317WMedicare PIN
R99672Medicare UPIN