Provider Demographics
NPI:1164885067
Name:CASILLO, DANIELLE (AGPCNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:
Last Name:CASILLO
Suffix:
Gender:F
Credentials:AGPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 YOUNGS RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221
Mailing Address - Country:US
Mailing Address - Phone:716-636-7990
Mailing Address - Fax:716-636-7993
Practice Address - Street 1:3950 E ROBINSON RD
Practice Address - Street 2:SUITE 207
Practice Address - City:WEST AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14228-2041
Practice Address - Country:US
Practice Address - Phone:716-564-1111
Practice Address - Fax:716-564-1128
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-30
Last Update Date:2017-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF307626207QA0505X
NYF307626-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJ400372417OtherMEDICARE