Provider Demographics
NPI:1154508687
Name:O'CONNELL, DANIELLE S (PA-C)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:S
Last Name:O'CONNELL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4885 OLENTANGY RIVER RD STE 1-20
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-1953
Mailing Address - Country:US
Mailing Address - Phone:614-268-6555
Mailing Address - Fax:614-457-5713
Practice Address - Street 1:4885 OLENTANGY RIVER RD STE 1-20
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-1953
Practice Address - Country:US
Practice Address - Phone:614-268-6555
Practice Address - Fax:614-457-5713
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-28
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.002926363A00000X
IL085003135363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0069246Medicaid
OH0069246Medicaid