Provider Demographics
NPI:1336841337
Name:CARRIS, DANIEL DAVID (DO)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:DAVID
Last Name:CARRIS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 NICOLLS RD
Mailing Address - Street 2:HEALTH SCIENCE CENTER T16, ROOM 020
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-8160
Mailing Address - Country:US
Mailing Address - Phone:631-444-7411
Mailing Address - Fax:
Practice Address - Street 1:100 NICOLLS RD
Practice Address - Street 2:HEALTH SCIENCE CENTER T16, ROOM 020
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11790-8160
Practice Address - Country:US
Practice Address - Phone:631-444-7411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-21
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program