Individual provider Active NPI

Dano Anthony Leli, PHD

  • Clinical Neuropsychologist
  • Maitland, FL
National Provider Identifier
1558328740
Registry record updated Sep 10, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical NeuropsychologistTaxonomy code 103G00000X
License
PY3919 Issued in FL
Practice address
500 N. Maitland Ave
Suite 110
Maitland, FL 32751
Phone
(407) 628-5354
Fax
(407) 628-0254
NPI assigned
May 1, 2006
Last updated
Sep 10, 2010By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 10, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Neuropsychologist 103G00000X PY003919 FL
Clinical Neuropsychologist 103G00000X PY3919 FL Primary
Psychologist 103T00000X PY3919 FL

Addresses

Primary practice location

500 N. Maitland Ave
Suite 110
Maitland, FL 32751

Mailing address

PO Box 947617
Maitland, FL 32794-7617
Phone (407) 628-5354

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20081114000562 FL Practitioner - Clinical Psychologist 5698835007 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
University of South Florida College of Medicine, 1978
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

500 N Maitland Ave
Suite 110
Maitland, FL 32751-9998
Phone (407) 628-5354

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
PY003919FLMDClinical Neuropsychologist
PY3919FLMDPsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Maitland Psychology PA Clinical Neuropsychologist CurrentSince May 25, 2007 Accepting new patients
Kristin P. Girardot, PH.D, LLC CurrentSince Oct 1, 2010 Accepting new patients

Locations

125 S Swoope Ave
Ste 212
Maitland, FL 32751
Phone (407) 628-5354

500 N Maitland Ave
Ste 110
Maitland, FL 32751
Phone (407) 628-5354

Networks

  • Freedom Health HMO Network

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1146441600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1284076800000",
    "number": "1558328740",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 947617",
            "city": "MAITLAND",
            "state": "FL",
            "postal_code": "327947617",
            "telephone_number": "407-628-5354",
            "fax_number": "407-628-0254"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 N. MAITLAND AVE",
            "address_2": "SUITE 110",
            "city": "MAITLAND",
            "state": "FL",
            "postal_code": "32751",
            "telephone_number": "407-628-5354",
            "fax_number": "407-628-0254"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LELI",
        "first_name": "DANO",
        "middle_name": "ANTHONY",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-05-01",
        "last_updated": "2010-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "FL",
            "license": "PY003919",
            "primary": false
        },
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "FL",
            "license": "PY3919",
            "primary": true
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "FL",
            "license": "PY3919",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Maitland, FL

Sources for this page

Verify at the official NPI Registry.