Provider Demographics
NPI:1396151049
Name:PROTO, DANIEL ANTHONY (PHD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:ANTHONY
Last Name:PROTO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 PALISADES RD
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-7912
Mailing Address - Country:US
Mailing Address - Phone:888-606-0086
Mailing Address - Fax:346-223-0296
Practice Address - Street 1:505 PALISADES RD
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-7912
Practice Address - Country:US
Practice Address - Phone:888-606-0086
Practice Address - Fax:346-223-0296
Is Sole Proprietor?:No
Enumeration Date:2014-07-02
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY10607103G00000X, 103TC0700X
KSLP 2203103G00000X
KSLP2203103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical