Provider Demographics
NPI:1952318644
Name:DESVALLONS, DANIELLE (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIELLE
Middle Name:
Last Name:DESVALLONS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7505 SW 173RD ST
Mailing Address - Street 2:
Mailing Address - City:VILLAGE OF PALMETTO BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-4838
Mailing Address - Country:US
Mailing Address - Phone:305-232-5451
Mailing Address - Fax:305-232-5401
Practice Address - Street 1:9333 SW 152ND ST
Practice Address - Street 2:
Practice Address - City:VILLAGE OF PALMETTO BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-1778
Practice Address - Country:US
Practice Address - Phone:305-256-5001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME65786207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL375-1643-00Medicaid
FLF20922Medicare UPIN
FL25175Medicare ID - Type Unspecified