Provider Demographics
NPI:1215103692
Name:SCHUPP, DANIELA (MD)
Entity type:Individual
Prefix:DR
First Name:DANIELA
Middle Name:
Last Name:SCHUPP
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 NORTH AVE, GRAND JUNCTION, CO
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-7512
Mailing Address - Country:US
Mailing Address - Phone:970-986-4418
Mailing Address - Fax:833-382-1178
Practice Address - Street 1:525 NORTH AVE
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-7512
Practice Address - Country:US
Practice Address - Phone:970-986-4418
Practice Address - Fax:833-382-1178
Is Sole Proprietor?:No
Enumeration Date:2008-05-05
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO48140208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery