Provider Demographics
NPI:1811218613
Name:KASSABOV, DANIELA (MD)
Entity Type:Individual
Prefix:
First Name:DANIELA
Middle Name:
Last Name:KASSABOV
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DANIELA
Other - Middle Name:
Other - Last Name:DRAGANOVA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 850001
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32885-0001
Mailing Address - Country:US
Mailing Address - Phone:941-747-2090
Mailing Address - Fax:941-556-7785
Practice Address - Street 1:11505 PALMBRUSH TRL
Practice Address - Street 2:SUITE 220
Practice Address - City:LAKEWOOD RANCH
Practice Address - State:FL
Practice Address - Zip Code:34202-2915
Practice Address - Country:US
Practice Address - Phone:941-747-2090
Practice Address - Fax:941-556-7785
Is Sole Proprietor?:No
Enumeration Date:2010-06-15
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN11015346A207Q00000X
FLME116023207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine