Provider Demographics
NPI:1942235437
Name:MASTROSIMONE, DANIELLE MICHELE (DC)
Entity Type:Individual
Prefix:DR
First Name:DANIELLE
Middle Name:MICHELE
Last Name:MASTROSIMONE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5941 LANCEWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34116-4811
Mailing Address - Country:US
Mailing Address - Phone:239-352-3208
Mailing Address - Fax:239-348-8404
Practice Address - Street 1:5941 LANCEWOOD WAY
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34116-4811
Practice Address - Country:US
Practice Address - Phone:239-352-3208
Practice Address - Fax:239-348-8404
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9189111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U90186Medicare UPIN