Healthcare Provider Details

I. General information

NPI: 1821080573
Provider Name (Legal Business Name): DANIELLE JOI SANCHACK PSY.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2005
Last Update Date: 02/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11512 LAKE MEAD AVE UNIT 704
JACKSONVILLE FL
32256-9682
US

IV. Provider business mailing address

2605 CODY DR
JACKSONVILLE FL
32223-5585
US

V. Phone/Fax

Practice location:
  • Phone: 904-616-5582
  • Fax:
Mailing address:
  • Phone: 904-616-5582
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1336
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: