Individual
DANIELLE ELISABETH DESERRES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3300 MAIN STREET, SPRINGFIELD, MA 01107-1112
(413) 794-5600
(413) 794-7297
Mailing address
280 CHESTNUT STREET, 2ND FL, SPRINGFIELD, MA 01199-1001
(413) 794-5700
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA5841
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110124266A
—
MA
Enumeration date
08/16/2016
Last updated
11/08/2019
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