Provider Demographics
NPI:1780024554
Name:DANELLA, MATTHEW M (PA-C)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:M
Last Name:DANELLA
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
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Mailing Address - Street 1:1 HIGH STREET
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02879-3103
Mailing Address - Country:US
Mailing Address - Phone:401-789-1422
Mailing Address - Fax:401-789-1422
Practice Address - Street 1:1706 MEDICAL BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34110-1417
Practice Address - Country:US
Practice Address - Phone:239-593-3500
Practice Address - Fax:239-593-3505
Is Sole Proprietor?:No
Enumeration Date:2013-06-26
Last Update Date:2022-09-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
RIPA00709363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant