Healthcare Provider Details

I. General information

NPI: 1487276655
Provider Name (Legal Business Name): RAISSA DANTAS ANSTETT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RAISSA WANDERLEY DANTAS

II. Dates (important events)

Enumeration Date: 05/11/2020
Last Update Date: 05/28/2025
Certification Date: 05/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 S STATE RD STE 210
SPRINGFIELD PA
19064-1243
US

IV. Provider business mailing address

400 S STATE RD STE 210
SPRINGFIELD PA
19064-1243
US

V. Phone/Fax

Practice location:
  • Phone: 610-623-9080
  • Fax: 610-623-3861
Mailing address:
  • Phone: 610-623-9080
  • Fax: 610-623-3861

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMT220546
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: