Provider Demographics
NPI:1093934382
Name:BERRY, DANELLE JEANNIE
Entity Type:Individual
Prefix:MS
First Name:DANELLE
Middle Name:JEANNIE
Last Name:BERRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3206 KINGS REALM AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43232-5498
Mailing Address - Country:US
Mailing Address - Phone:614-615-2078
Mailing Address - Fax:
Practice Address - Street 1:3206 KINGS REALM AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43232-5498
Practice Address - Country:US
Practice Address - Phone:614-615-2078
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health