=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982468112
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DANIKA DELLANNO
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/08/2024
-----------------------------------------------------
Last Update Date | 02/08/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5501 OLD YORK RD
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19141-3018
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-456-7891
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 111 PROGRESS DR
-----------------------------------------------------
City | CONSHOHOCKEN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19428-1277
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-423-1894
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Nurse Practitioner
-----------------------------------------------------
License Number | SP028990
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------