Provider Demographics
NPI:1376817395
Name:JEAN-CHARLES, DANIELLE KATHY
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:KATHY
Last Name:JEAN-CHARLES
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 1:1430 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11106-4530
Mailing Address - Country:US
Mailing Address - Phone:718-545-7095
Mailing Address - Fax:
Practice Address - Street 1:1430 BROADWAY
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11106-4530
Practice Address - Country:US
Practice Address - Phone:718-545-7095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-08
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY498107-1163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool