Provider Demographics
NPI:1942500947
Name:DANFORD, EBONY A
Entity Type:Individual
Prefix:MISS
First Name:EBONY
Middle Name:A
Last Name:DANFORD
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 1:3110 POLARIS AVE STE 35
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-8360
Mailing Address - Country:US
Mailing Address - Phone:702-969-2817
Mailing Address - Fax:702-359-0041
Practice Address - Street 1:800 N RAINBOW BLVD
Practice Address - Street 2:STE 200
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89107-1189
Practice Address - Country:US
Practice Address - Phone:702-642-3355
Practice Address - Fax:702-642-3355
Is Sole Proprietor?:No
Enumeration Date:2010-10-25
Last Update Date:2018-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner