Provider Demographics
NPI:1982212478
Name:HENNESSEY, DANIEL (DPM)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:
Last Name:HENNESSEY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:699 BEAVER ST UNIT 1142
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:PA
Mailing Address - Zip Code:19007-3888
Mailing Address - Country:US
Mailing Address - Phone:727-403-0333
Mailing Address - Fax:
Practice Address - Street 1:12401 ACADEMY RD STE 201
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19154-1934
Practice Address - Country:US
Practice Address - Phone:215-637-3121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-21
Last Update Date:2025-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC007226213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT061.0000029Medicaid
PASC007226Medicaid