Provider Demographics
NPI:1073686382
Name:PHELAN, DANIELLE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:DANIELLE
Middle Name:
Last Name:PHELAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 E SHORE RD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030-2900
Mailing Address - Country:US
Mailing Address - Phone:516-510-6980
Mailing Address - Fax:
Practice Address - Street 1:333 E SHORE RD
Practice Address - Street 2:SUITE 206
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030-2900
Practice Address - Country:US
Practice Address - Phone:516-510-6980
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY15311103TP0814X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysis
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYVL9661Medicare PIN