Provider Demographics
NPI:1215475587
Name:PRUSZYNSKI, DAUREEN (LMT)
Entity type:Individual
Prefix:
First Name:DAUREEN
Middle Name:
Last Name:PRUSZYNSKI
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2753 SR 580
Mailing Address - Street 2:SUITE 205
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33761-3345
Mailing Address - Country:US
Mailing Address - Phone:727-736-9288
Mailing Address - Fax:
Practice Address - Street 1:2753 HIGHWAY 580
Practice Address - Street 2:SUITE 205
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33761-3345
Practice Address - Country:US
Practice Address - Phone:727-736-9288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-07
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA36464174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist