Healthcare Provider Details

I. General information

NPI: 1669304143
Provider Name (Legal Business Name): DANIELLE OPPEDISANO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 W THOMAS RD
PHOENIX AZ
85013-4409
US

IV. Provider business mailing address

6732 W SACK DR
GLENDALE AZ
85308-5744
US

V. Phone/Fax

Practice location:
  • Phone: 203-209-0419
  • Fax:
Mailing address:
  • Phone: 203-209-0419
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN195038
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: