Provider Demographics
NPI:1043543259
Name:DANIELLI-PEASE, LISA
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:DANIELLI-PEASE
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 1:21 STEINER DR
Mailing Address - Street 2:
Mailing Address - City:MAHOPAC
Mailing Address - State:NY
Mailing Address - Zip Code:10541-1050
Mailing Address - Country:US
Mailing Address - Phone:845-628-8228
Mailing Address - Fax:845-628-6647
Practice Address - Street 1:21 STEINER DR
Practice Address - Street 2:
Practice Address - City:MAHOPAC
Practice Address - State:NY
Practice Address - Zip Code:10541-1050
Practice Address - Country:US
Practice Address - Phone:845-628-8228
Practice Address - Fax:845-628-6647
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-08
Last Update Date:2009-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004139246ZA2600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZA2600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherArt, Medical