Healthcare Provider Details

I. General information

NPI: 1649155722
Provider Name (Legal Business Name): DANIELLE ELIZABETH BRODEN-NEALEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DANIELLE ELIZABETH BRODEN

II. Dates (important events)

Enumeration Date: 08/07/2025
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date: 09/24/2025
Reactivation Date: 05/11/2026

III. Provider practice location address

301 PENNY LN
MOREHEAD CITY NC
28557-4307
US

IV. Provider business mailing address

PO BOX 101
NEWPORT NC
28570-0101
US

V. Phone/Fax

Practice location:
  • Phone: 252-648-0347
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP023088
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: