Provider Demographics
NPI:1801964788
Name:RUSOVICI, DANIELA E (MD)
Entity type:Individual
Prefix:DR
First Name:DANIELA
Middle Name:E
Last Name:RUSOVICI
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Gender:F
Credentials:MD
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Mailing Address - Street 1:7075 N US HIGHWAY 1
Mailing Address - Street 2:SUITE 150
Mailing Address - City:PORT ST JOHN
Mailing Address - State:FL
Mailing Address - Zip Code:32927-5216
Mailing Address - Country:US
Mailing Address - Phone:321-268-6264
Mailing Address - Fax:321-633-8617
Practice Address - Street 1:5005 PORT ST JOHN PKWY
Practice Address - Street 2:SUITE 2200
Practice Address - City:PORT ST JOHN
Practice Address - State:FL
Practice Address - Zip Code:32927-4305
Practice Address - Country:US
Practice Address - Phone:321-633-8660
Practice Address - Fax:321-633-8617
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2015-02-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME1036092084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002534800Medicaid
FLDO187XMedicare PIN