Provider Demographics
NPI:1003296419
Name:FERNANDEZ, DAPHNE
Entity Type:Individual
Prefix:MS
First Name:DAPHNE
Middle Name:
Last Name:FERNANDEZ
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 1:110 UNION RD
Mailing Address - Street 2:APT. 3L
Mailing Address - City:SPRING VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10977-3447
Mailing Address - Country:US
Mailing Address - Phone:646-387-7670
Mailing Address - Fax:
Practice Address - Street 1:110 UNION RD
Practice Address - Street 2:APT. 3L
Practice Address - City:SPRING VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10977-3447
Practice Address - Country:US
Practice Address - Phone:646-387-7670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-02
Last Update Date:2015-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist