Provider Demographics
NPI:1013884063
Name:ANDERSON KELLY, DANIELLE
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:ANDERSON KELLY
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 1:111 ZENITH LOOP
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23601-1277
Mailing Address - Country:US
Mailing Address - Phone:757-302-7774
Mailing Address - Fax:855-498-1291
Practice Address - Street 1:606 DENBIGH BLVD STE 301
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23608-4486
Practice Address - Country:US
Practice Address - Phone:757-302-7774
Practice Address - Fax:855-498-1291
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-22
Last Update Date:2025-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246Q00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyGroup - Multi-Specialty
No291U00000XLaboratoriesClinical Medical Laboratory