Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | F306279-1 | NY |
NPI | 1003152323 |
---|---|
Provider Name | Annie Leela Durairaj Daniel |
First Address | Oceanside, NY 11572-4235 |
Second Address | Oceanside, NY 11572-4235 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2012 |
Last Update Date | 13/12/2012 |