Basic Information
| Provider Information | |||||||||
| NPI: | 1215695523 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CLAUSELL | ||||||||
| FirstName: | MADELINE | ||||||||
| MiddleName: | DANIELLE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3803 WIGGINS LEAF ST | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336191052 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4047516858 | ||||||||
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| Practice Location | |||||||||
| Address1: | 10817 BLOOMINGDALE AVE | ||||||||
| Address2: | |||||||||
| City: | RIVERVIEW | ||||||||
| State: | FL | ||||||||
| PostalCode: | 335783616 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8133241342 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/03/2021 | ||||||||
| LastUpdateDate: | 12/03/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/03/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | Y |
No ID Information.