Provider Demographics
NPI:1427351584
Name:SORVILLO FERREIRA, DANIELA (LAC, MSOM, LOBT)
Entity type:Individual
Prefix:
First Name:DANIELA
Middle Name:
Last Name:SORVILLO FERREIRA
Suffix:
Gender:F
Credentials:LAC, MSOM, LOBT
Other - Prefix:
Other - First Name:DANIELA
Other - Middle Name:
Other - Last Name:SORVILLO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAC, MSOM, LOBT
Mailing Address - Street 1:140 WILSON AVE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07105-3326
Mailing Address - Country:US
Mailing Address - Phone:973-491-0022
Mailing Address - Fax:973-368-2287
Practice Address - Street 1:140 WILSON AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07105-3326
Practice Address - Country:US
Practice Address - Phone:973-491-0022
Practice Address - Fax:973-368-2287
Is Sole Proprietor?:No
Enumeration Date:2010-12-13
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00052800171100000X
FLAP 1723171100000X
NJ26BT00029800225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist