Provider Demographics
NPI:1326643230
Name:CONNOR, DARIELLE ASHLEY
Entity Type:Individual
Prefix:MS
First Name:DARIELLE
Middle Name:ASHLEY
Last Name:CONNOR
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 1:9420 GUY R BREWER BLVD
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11451-0001
Mailing Address - Country:US
Mailing Address - Phone:718-262-2823
Mailing Address - Fax:
Practice Address - Street 1:9420 GUY R BREWER BLVD
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11451-0001
Practice Address - Country:US
Practice Address - Phone:718-262-2823
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY363A00000X363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY446408OtherAMERICAN REGISTRY OF RADIOLOGIC TECHNOLOGISTS