Provider Demographics
NPI:1689195521
Name:DANIEL DSTTEFFANO, MD & ASSOCIATES
Entity Type:Organization
Organization Name:DANIEL DSTTEFFANO, MD & ASSOCIATES
Other - Org Name:MINDFUL BALANCE AND WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DSTTEFFANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-261-0107
Mailing Address - Street 1:719 BENTON AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34601-3213
Mailing Address - Country:US
Mailing Address - Phone:352-261-0107
Mailing Address - Fax:352-559-8685
Practice Address - Street 1:719 BENTON AVE
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34601-3213
Practice Address - Country:US
Practice Address - Phone:352-261-0107
Practice Address - Fax:352-559-8685
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLACN563246ZE0600X, 261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnosticGroup - Multi-Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Multi-Specialty