Individual
DANIELLE IMANI ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
55 FRUIT ST, BOSTON, MA 02114-2621
(617) 726-2803
Mailing address
610 SORRELL SPRING CT, WAXHAW, NC 28173-7454
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
03/24/2020
Last updated
03/24/2020
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