Healthcare Provider Details

I. General information

NPI: 1215198924
Provider Name (Legal Business Name): DANIELA A HUMPHREY DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2008
Last Update Date: 02/14/2022
Certification Date: 02/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

433 N CLEVELAND AVE
WESTERVILLE OH
43082-8095
US

IV. Provider business mailing address

700 CHILDREN'S DRIVE
COLUMBUS OH
43205-2664
US

V. Phone/Fax

Practice location:
  • Phone: 614-355-8300
  • Fax:
Mailing address:
  • Phone: 614-722-2000
  • Fax: 614-722-4380

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number34011532
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License Number34011532
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: