Provider Demographics
NPI:1407320971
Name:ANANE, CRESSALYN
Entity Type:Individual
Prefix:MRS
First Name:CRESSALYN
Middle Name:
Last Name:ANANE
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 1:5905 SANDRINGHAM CT
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22315-4143
Mailing Address - Country:US
Mailing Address - Phone:813-374-2070
Mailing Address - Fax:813-337-0937
Practice Address - Street 1:5905 SANDRINGHAM CT
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22315-4143
Practice Address - Country:US
Practice Address - Phone:813-374-2070
Practice Address - Fax:813-337-0937
Is Sole Proprietor?:No
Enumeration Date:2019-01-17
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist