Provider Demographics
NPI:1265851992
Name:REPALONE, DANIELLE
Entity Type:Individual
Prefix:MS
First Name:DANIELLE
Middle Name:
Last Name:REPALONE
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 1:581 BEAVER LN
Mailing Address - Street 2:
Mailing Address - City:RONKONKOMA
Mailing Address - State:NY
Mailing Address - Zip Code:11779-6018
Mailing Address - Country:US
Mailing Address - Phone:631-478-5957
Mailing Address - Fax:
Practice Address - Street 1:581 BEAVER LN
Practice Address - Street 2:
Practice Address - City:RONKONKOMA
Practice Address - State:NY
Practice Address - Zip Code:11779-6018
Practice Address - Country:US
Practice Address - Phone:631-478-5957
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-09
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program