Provider Demographics
NPI:1659717858
Name:FISHER, DANIEL MASON (EDS)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:MASON
Last Name:FISHER
Suffix:
Gender:M
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E SYBELIA AVE STE 260
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-4709
Mailing Address - Country:US
Mailing Address - Phone:321-209-2444
Mailing Address - Fax:
Practice Address - Street 1:100 E SYBELIA AVE STE 260
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-4709
Practice Address - Country:US
Practice Address - Phone:321-209-2444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-14
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH13042101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health