Healthcare Provider Details

I. General information

NPI: 1255520441
Provider Name (Legal Business Name): DANIEL PATRICK DISALVO CNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2007
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2323 W 5TH AVE STE 120
COLUMBUS OH
43204-4899
US

IV. Provider business mailing address

PO BOX 10014
COLUMBUS OH
43201-0514
US

V. Phone/Fax

Practice location:
  • Phone: 380-219-0738
  • Fax: 614-485-7928
Mailing address:
  • Phone: 380-219-0738
  • Fax: 614-485-7928

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.07396
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: