Provider Demographics
NPI:1891366969
Name:DE LA FUENTE, DANIELLE LIANA (AUD)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:LIANA
Last Name:DE LA FUENTE
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5860 RANCH LAKE BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD RANCH
Mailing Address - State:FL
Mailing Address - Zip Code:34202-3719
Mailing Address - Country:US
Mailing Address - Phone:941-229-2122
Mailing Address - Fax:941-757-3732
Practice Address - Street 1:5860 RANCH LAKE BLVD STE 110
Practice Address - Street 2:
Practice Address - City:LAKEWOOD RANCH
Practice Address - State:FL
Practice Address - Zip Code:34202-3719
Practice Address - Country:US
Practice Address - Phone:941-229-2122
Practice Address - Fax:941-757-3732
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-08
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY2483237600000X, 231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter