Provider Demographics
NPI:1548656952
Name:GUSTAW, DANYELL
Entity type:Individual
Prefix:MRS
First Name:DANYELL
Middle Name:
Last Name:GUSTAW
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 1:7413 PAINTED RIDGE ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89131-4719
Mailing Address - Country:US
Mailing Address - Phone:702-720-4362
Mailing Address - Fax:
Practice Address - Street 1:6955 N DURANGO DR UNIT 1004
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89149-4412
Practice Address - Country:US
Practice Address - Phone:702-720-4362
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-13
Last Update Date:2025-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner