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General NPI Number Information
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NPI Number | 1144854357
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Entity Type | Individual
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Provider Name | DANIELLE VIEIRA C. PED
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Gender | Female
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Dates
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Enumeration Date | 02/26/2020
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Last Update Date | 02/26/2020
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Provider Practice Location Address
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Address Line | 17 WHITE HORSE PIKE STE 10A
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City | HADDON HEIGHTS
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State | NJ
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Zip | 08035-1239
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Country | US
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Telephone | 856-546-8989
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Fax | 856-546-8905
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Provider Business Mailing Address
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Address Line | 17 WHITE HORSE PIKE STE 10A
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City | HADDON HEIGHTS
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State | NJ
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Zip | 08035-1239
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Country | US
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Telephone | 856-546-8989
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Fax | 856-546-8995
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224L00000X
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Taxonomy Name | Pedorthist
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License Number | 45PD00001200
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License Number State | NJ
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