Provider Demographics
NPI:1679713697
Name:SALLEY, DANIELLE ARTASCIA (PA)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:ARTASCIA
Last Name:SALLEY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 1471
Mailing Address - Street 2:
Mailing Address - City:MERRIFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22116
Mailing Address - Country:US
Mailing Address - Phone:202-269-7439
Mailing Address - Fax:202-269-7470
Practice Address - Street 1:1160 VARNUM ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20017
Practice Address - Country:US
Practice Address - Phone:202-269-7439
Practice Address - Fax:202-269-7470
Is Sole Proprietor?:No
Enumeration Date:2009-03-03
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPA030481363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCPA030481OtherPHYSICIAN ASST