Provider Demographics
NPI:1457453938
Name:DANALYNN GUASTEFERRO DPM PC
Entity Type:Organization
Organization Name:DANALYNN GUASTEFERRO DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANALYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:GUASTEFERRO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:205-918-9181
Mailing Address - Street 1:2261 WHITE WAY
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35226-3125
Mailing Address - Country:US
Mailing Address - Phone:205-405-0567
Mailing Address - Fax:205-699-1135
Practice Address - Street 1:2660 10TH AVE S STE 608
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-1627
Practice Address - Country:US
Practice Address - Phone:205-918-9181
Practice Address - Fax:205-918-6699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-04
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL175213ES0103X
261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatricGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALK142OtherMEDICARE GROUP NUMBER
ALU68472Medicare UPIN