Provider Demographics
NPI:1780912832
Name:FANEUF, DANIEL J (HIS)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:J
Last Name:FANEUF
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:485 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:NH
Mailing Address - Zip Code:03842-2349
Mailing Address - Country:US
Mailing Address - Phone:603-319-1701
Mailing Address - Fax:603-319-1713
Practice Address - Street 1:750 LAFAYETTE RD
Practice Address - Street 2:SUITE 102
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-5407
Practice Address - Country:US
Practice Address - Phone:603-319-1701
Practice Address - Fax:603-319-1713
Is Sole Proprietor?:No
Enumeration Date:2009-12-01
Last Update Date:2013-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHH584237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3086157Medicaid