Basic Information
| Provider Information | |||||||||
| NPI: | 1902413917 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WELFORD | ||||||||
| FirstName: | DANIELLE | ||||||||
| MiddleName: | M | ||||||||
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| Mailing Information | |||||||||
| Address1: | 550 SOLUTIONS WAY ROCKLEDGE | ||||||||
| Address2: | |||||||||
| City: | ROCKLEDGE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32955 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3214271823 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3042 NINA CT | ||||||||
| Address2: | |||||||||
| City: | MERRITT ISLAND | ||||||||
| State: | FL | ||||||||
| PostalCode: | 329538317 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3216399800 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/24/2020 | ||||||||
| LastUpdateDate: | 09/24/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/16/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | Y |
No ID Information.