Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QA0505X | Family Doctor - Adult Medicine | F307626 | NY |
Y | 363LA2200X | Nurse Practitioner - Adult Health | F307626-1 | NY |
NPI | 1164885067 |
---|---|
Provider Name | Mrs. Danielle Casillo |
First Address | Williamsville, NY 14221 |
Second Address | West Amherst, NY 14228-2041 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2016 |
Last Update Date | 09/08/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
J400372417 | MEDICARE (01) | NY |