Provider Demographics
NPI:1386668309
Name:TRIANA, REBECCA DANIELLE (RPA-C,MSPAS)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:DANIELLE
Last Name:TRIANA
Suffix:
Gender:F
Credentials:RPA-C,MSPAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:PO BOX 252
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11768-0252
Mailing Address - Country:US
Mailing Address - Phone:917-746-5436
Mailing Address - Fax:702-485-6746
Practice Address - Street 1:5036 JERICHO TPKE STE 203
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-2812
Practice Address - Country:US
Practice Address - Phone:917-746-5436
Practice Address - Fax:702-485-6746
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY007350363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant