Healthcare Provider Details

I. General information

NPI: 1457453938
Provider Name (Legal Business Name): DANALYNN GUASTEFERRO DPM PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2006
Last Update Date: 09/16/2020
Certification Date: 09/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2660 10TH AVE S STE 608
BIRMINGHAM AL
35205-1627
US

IV. Provider business mailing address

2261 WHITE WAY
HOOVER AL
35226-3125
US

V. Phone/Fax

Practice location:
  • Phone: 205-918-9181
  • Fax: 205-918-6699
Mailing address:
  • Phone: 205-405-0567
  • Fax: 205-699-1135

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number175
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. DANALYNN GUASTEFERRO
Title or Position: PRESIDENT
Credential: DPM
Phone: 205-918-9181