Provider Demographics
NPI:1174543573
Name:HUSTED, DANIEL SHAKESPEARE (MD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:SHAKESPEARE
Last Name:HUSTED
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1050 SE MONTEREY RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-4512
Mailing Address - Country:US
Mailing Address - Phone:772-288-2400
Mailing Address - Fax:772-419-0144
Practice Address - Street 1:1050 SE MONTEREY RD STE 400
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-4512
Practice Address - Country:US
Practice Address - Phone:772-288-2400
Practice Address - Fax:772-419-0144
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME96130207X00000X, 207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
I40573Medicare UPIN
56378ZMedicare ID - Type Unspecified