Provider Demographics
NPI:1609521038
Name:DANIELS, ANDREANA M
Entity Type:Individual
Prefix:
First Name:ANDREANA
Middle Name:M
Last Name:DANIELS
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 1:3526 GATLING AVE APT B
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-3132
Mailing Address - Country:US
Mailing Address - Phone:180-388-8059
Mailing Address - Fax:
Practice Address - Street 1:3526 GATLING AVE APT B
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-3132
Practice Address - Country:US
Practice Address - Phone:180-388-8059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-15
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1327