Provider Demographics
NPI:1750856910
Name:GREENBLATT, DANIEL MICHAEL (AUD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:MICHAEL
Last Name:GREENBLATT
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19423 N R H JOHNSON BLVD STE 127
Mailing Address - Street 2:
Mailing Address - City:SUN CITY WEST
Mailing Address - State:AZ
Mailing Address - Zip Code:85375-4565
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15802 N PARKVIEW PL
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-7466
Practice Address - Country:US
Practice Address - Phone:561-310-0335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-03
Last Update Date:2024-02-28
Deactivation Date:2021-11-22
Deactivation Code:
Reactivation Date:2023-07-31
Provider Licenses
StateLicense IDTaxonomies
231H00000X
AZDA11507237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty