MEDICARE: DANIELLE WHITNEY JEFFERSON ATC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255A2300X	Athletic Trainer

General Provider Information

NPI Number	:	1548833213
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIELLE WHITNEY JEFFERSON ATC

Provider Business Mailing Address
First Line	:	20432 NW 18TH AVE
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33056-5046
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	20432 NW 18TH AVE
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33056-5046
Country	:	US
Telephone Number	:	305-725-9881
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/21/2021
Last Update Date	:	06/14/2023

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