Provider Demographics
NPI:1295010767
Name:KHORSANDI, DANIELLE (APRN)
Entity Type:Individual
Prefix:MS
First Name:DANIELLE
Middle Name:
Last Name:KHORSANDI
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 BOSTON POST RD
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-2574
Mailing Address - Country:US
Mailing Address - Phone:203-882-2066
Mailing Address - Fax:203-882-2074
Practice Address - Street 1:321 BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-2574
Practice Address - Country:US
Practice Address - Phone:203-882-2066
Practice Address - Fax:203-882-2074
Is Sole Proprietor?:No
Enumeration Date:2011-10-17
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0048358363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily