Provider Demographics
NPI:1720789506
Name:SPENCER-LAITT, DANIELLA MIRIAM
Entity type:Individual
Prefix:MS
First Name:DANIELLA
Middle Name:MIRIAM
Last Name:SPENCER-LAITT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 MARLBOROUGH ST APT 6
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116-1940
Mailing Address - Country:US
Mailing Address - Phone:347-522-0740
Mailing Address - Fax:
Practice Address - Street 1:1 BOWDOIN SQ FL 6
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2927
Practice Address - Country:US
Practice Address - Phone:866-449-6779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-17
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program