Healthcare Provider Details

I. General information

NPI: 1396756821
Provider Name (Legal Business Name): DANIELLE S. WALSH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 06/17/2025
Certification Date: 06/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 S LIMESTONE STE 201
LEXINGTON KY
40536-2849
US

IV. Provider business mailing address

3803 CHARLESTON CT
GREENVILLE NC
27834-7667
US

V. Phone/Fax

Practice location:
  • Phone: 859-218-2522
  • Fax: 859-323-3918
Mailing address:
  • Phone: 252-481-1238
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License NumberME90213
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License Number2011-00774
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License Number56535
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: