Healthcare Provider Details

I. General information

NPI: 1275910358
Provider Name (Legal Business Name): DANIELLE VAN SHAAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2015
Last Update Date: 04/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25263 CHAMBER OF COMMERCE DR
BONITA SPRINGS FL
34135-7887
US

IV. Provider business mailing address

1234 E AIRPORT RD
SAFFORD AZ
85546-9147
US

V. Phone/Fax

Practice location:
  • Phone: 239-947-0800
  • Fax:
Mailing address:
  • Phone: 928-965-4873
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231HA2500X
TaxonomyAssistive Technology Supplier Audiologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: