Provider Demographics
NPI:1770923906
Name:DENNISON, DANIEL SULLIVAN (MD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:SULLIVAN
Last Name:DENNISON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6518 SURFSIDE BLVD
Mailing Address - Street 2:
Mailing Address - City:APOLLO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33572-3008
Mailing Address - Country:US
Mailing Address - Phone:813-645-0510
Mailing Address - Fax:813-645-0510
Practice Address - Street 1:6518 SURFSIDE BLVD
Practice Address - Street 2:
Practice Address - City:APOLLO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33572-3008
Practice Address - Country:US
Practice Address - Phone:813-645-0510
Practice Address - Fax:813-645-0510
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-02
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 22305207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine