Provider Demographics
NPI:1457749491
Name:FENNELL, DANIEL
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:FENNELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1665 DUNLAWTON AVE
Mailing Address - Street 2:SUITE 107
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32127-2919
Mailing Address - Country:US
Mailing Address - Phone:904-770-2333
Mailing Address - Fax:
Practice Address - Street 1:1665 DUNLAWTON AVE
Practice Address - Street 2:SUITE 107
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32127-2919
Practice Address - Country:US
Practice Address - Phone:904-770-2333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-29
Last Update Date:2014-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist