Provider Demographics
NPI:1255803995
Name:DANKO, TRACY SHANNON
Entity type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:SHANNON
Last Name:DANKO
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 1:9243 ANDOVER RD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19114-3818
Mailing Address - Country:US
Mailing Address - Phone:267-359-9903
Mailing Address - Fax:
Practice Address - Street 1:9243 ANDOVER RD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114-3818
Practice Address - Country:US
Practice Address - Phone:267-359-9903
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-19
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA10066073376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide