Provider Demographics
NPI:1801500582
Name:CANNON, DANIELLE SHEREE'
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:SHEREE'
Last Name:CANNON
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 1:17 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEVILLE
Mailing Address - State:DE
Mailing Address - Zip Code:19933-1010
Mailing Address - Country:US
Mailing Address - Phone:302-604-9479
Mailing Address - Fax:
Practice Address - Street 1:20446 CAMP RD
Practice Address - Street 2:
Practice Address - City:BRIDGEVILLE
Practice Address - State:DE
Practice Address - Zip Code:19933-4621
Practice Address - Country:US
Practice Address - Phone:302-396-5397
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-09
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEPASA-088374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEPASA-088OtherPERSONAL ASSISTANCE SERVICE AGENCY