Provider Demographics
NPI:1750337432
Name:DALESSIO, DANIELLE FLORENCE (PA)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:FLORENCE
Last Name:DALESSIO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 647
Mailing Address - Street 2:GOHEALTH
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-0167
Mailing Address - Country:US
Mailing Address - Phone:503-666-5050
Mailing Address - Fax:503-666-7410
Practice Address - Street 1:2850 SE POWELL VALLEY RD STE 100
Practice Address - Street 2:ATTN: MEG NAU
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97080-1495
Practice Address - Country:US
Practice Address - Phone:503-666-5050
Practice Address - Fax:503-666-7410
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009527363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY009527OtherNY LICENSE NUMBER
Q23638Medicare UPIN