Provider Demographics
NPI:1205442993
Name:MASWAU, DANIEL S (CERTFIED NURSE ASST)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:S
Last Name:MASWAU
Suffix:
Gender:M
Credentials:CERTFIED NURSE ASST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 WEKIVA CREST DR
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32712-1476
Mailing Address - Country:US
Mailing Address - Phone:407-371-2527
Mailing Address - Fax:
Practice Address - Street 1:625 WEKIVA CREST DR
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32712-1476
Practice Address - Country:US
Practice Address - Phone:407-371-2527
Practice Address - Fax:407-703-8152
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-18
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL103495600261QD1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL103495600Medicaid