Provider Demographics
NPI:1750856910
Name:GREENBLATT, DANIEL MICHAEL (AUD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:MICHAEL
Last Name:GREENBLATT
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19423 N R H JOHNSON BLVD STE 127
Mailing Address - Street 2:
Mailing Address - City:SUN CITY WEST
Mailing Address - State:AZ
Mailing Address - Zip Code:85375-4565
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14973 W BELL RD STE 150
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-3637
Practice Address - Country:US
Practice Address - Phone:602-863-4203
Practice Address - Fax:602-863-4216
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-03
Last Update Date:2025-07-01
Deactivation Date:2021-11-22
Deactivation Code:
Reactivation Date:2023-07-31
Provider Licenses
StateLicense IDTaxonomies
AZDA11507231H00000X, 237600000X
231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter