Provider Demographics
NPI:1396955134
Name:DANIACHEW, AMANUEL AMBAYE (MD)
Entity type:Individual
Prefix:DR
First Name:AMANUEL
Middle Name:AMBAYE
Last Name:DANIACHEW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:13055 SUMMERFIELD SQUARE DR
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33578-7402
Mailing Address - Country:US
Mailing Address - Phone:813-741-2473
Mailing Address - Fax:813-672-6197
Practice Address - Street 1:13055 SUMMERFIELD SQUARE DR
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33578-7402
Practice Address - Country:US
Practice Address - Phone:813-741-2473
Practice Address - Fax:813-672-6197
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2023-06-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME153168207RA0401X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine