Provider Demographics
NPI:1487276655
Name:ANSTETT, RAISSA DANTAS (MD)
Entity type:Individual
Prefix:
First Name:RAISSA
Middle Name:DANTAS
Last Name:ANSTETT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:RAISSA
Other - Middle Name:WANDERLEY
Other - Last Name:DANTAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:400 S STATE RD STE 210
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:19064-1243
Mailing Address - Country:US
Mailing Address - Phone:610-623-9080
Mailing Address - Fax:610-623-3861
Practice Address - Street 1:400 S STATE RD STE 210
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:PA
Practice Address - Zip Code:19064-1243
Practice Address - Country:US
Practice Address - Phone:610-623-9080
Practice Address - Fax:610-623-3861
Is Sole Proprietor?:No
Enumeration Date:2020-05-11
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT220546208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics