Provider Demographics
NPI:1144854357
Name:VIEIRA, DANIELLE (C PED)
Entity type:Individual
Prefix:MISS
First Name:DANIELLE
Middle Name:
Last Name:VIEIRA
Suffix:
Gender:F
Credentials:C PED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 WHITE HORSE PIKE STE 10A
Mailing Address - Street 2:
Mailing Address - City:HADDON HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:08035-1239
Mailing Address - Country:US
Mailing Address - Phone:856-546-8989
Mailing Address - Fax:856-546-8995
Practice Address - Street 1:17 WHITE HORSE PIKE STE 10A
Practice Address - Street 2:
Practice Address - City:HADDON HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:08035-1239
Practice Address - Country:US
Practice Address - Phone:856-546-8989
Practice Address - Fax:856-546-8905
Is Sole Proprietor?:No
Enumeration Date:2020-02-26
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ45PD00001200224L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224L00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPedorthist