Provider Demographics
NPI:1396743332
Name:DALESANDRO, JOY (MD)
Entity type:Individual
Prefix:DR
First Name:JOY
Middle Name:
Last Name:DALESANDRO
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 1:3640 HIGH ST
Mailing Address - Street 2:SUITE 2D
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23707-3213
Mailing Address - Country:US
Mailing Address - Phone:757-398-2222
Mailing Address - Fax:757-398-2020
Practice Address - Street 1:3640 HIGH ST
Practice Address - Street 2:SUITE 2D
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23707-3213
Practice Address - Country:US
Practice Address - Phone:757-398-2222
Practice Address - Fax:757-398-2020
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2009-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101233423208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
197596OtherANTHEM
VA58412OtherOPTIMA
VA010287286Medicaid
VA89065UEOtherMEDICAID OF NC
VAMC12777Medicare PIN
197596OtherANTHEM
VA010287286Medicaid