Healthcare Provider Details

I. General information

NPI: 1750337432
Provider Name (Legal Business Name): DANIELLE FLORENCE DALESSIO PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 05/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2850 SE POWELL VALLEY RD STE 100 ATTN: MEG NAU
GRESHAM OR
97080-1495
US

IV. Provider business mailing address

PO BOX 647 GOHEALTH
GRESHAM OR
97030-0167
US

V. Phone/Fax

Practice location:
  • Phone: 503-666-5050
  • Fax: 503-666-7410
Mailing address:
  • Phone: 503-666-5050
  • Fax: 503-666-7410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number009527
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: