Provider Demographics
NPI:1518526979
Name:BAKER, DANIELLESHERRI WANDA (171M00000X)
Entity Type:Individual
Prefix:
First Name:DANIELLESHERRI
Middle Name:WANDA
Last Name:BAKER
Suffix:
Gender:F
Credentials:171M00000X
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2750 SUTTERVILLE RD
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95820-1024
Mailing Address - Country:US
Mailing Address - Phone:916-787-7678
Mailing Address - Fax:
Practice Address - Street 1:2750 SUTTERVILLE RD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95820-1024
Practice Address - Country:US
Practice Address - Phone:916-787-7678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-10
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator