Healthcare Provider Details

I. General information

NPI: 1306272182
Provider Name (Legal Business Name): DANIELLE SANDELLA ALFORD PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2013
Last Update Date: 05/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3857 COOPER ST
JACKSON MI
49201
US

IV. Provider business mailing address

2249 CHESTNUT CRES
SALINE MI
48176-1681
US

V. Phone/Fax

Practice location:
  • Phone: 517-780-5601
  • Fax:
Mailing address:
  • Phone: 734-431-9168
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number5601006806
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: