Provider Demographics
NPI:1558258053
Name:STANFORD, DANELL
Entity type:Individual
Prefix:
First Name:DANELL
Middle Name:
Last Name:STANFORD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2492 HAVERHILL RD
Mailing Address - Street 2:
Mailing Address - City:FAIRLAWN
Mailing Address - State:OH
Mailing Address - Zip Code:44333-3812
Mailing Address - Country:US
Mailing Address - Phone:330-834-5228
Mailing Address - Fax:
Practice Address - Street 1:2492 HAVERHILL RD
Practice Address - Street 2:
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-3812
Practice Address - Country:US
Practice Address - Phone:330-809-9039
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-18
Last Update Date:2025-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver
No372600000XNursing Service Related ProvidersAdult Companion