Provider Demographics
NPI:1003450941
Name:CAVALLO-FAT, DANIELLE SUSAN (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:SUSAN
Last Name:CAVALLO-FAT
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1008 BOWLING GREEN TRL
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-3144
Mailing Address - Country:US
Mailing Address - Phone:757-353-7525
Mailing Address - Fax:
Practice Address - Street 1:1008 BOWLING GREEN TRL
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-3144
Practice Address - Country:US
Practice Address - Phone:757-353-7525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-04
Last Update Date:2019-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024178449363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily