Provider Demographics
NPI:1346055985
Name:DANIELS, DAVON DEMITRIUS
Entity type:Individual
Prefix:
First Name:DAVON
Middle Name:DEMITRIUS
Last Name:DANIELS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1140 SW 27TH ST APT 302
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68522-1056
Mailing Address - Country:US
Mailing Address - Phone:712-899-9004
Mailing Address - Fax:
Practice Address - Street 1:7215 DORCHESTER CT
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68521-5853
Practice Address - Country:US
Practice Address - Phone:712-899-9004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-11
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health