Provider Demographics
NPI:1437300571
Name:DANIEL, LETHA SERA (MD)
Entity Type:Individual
Prefix:DR
First Name:LETHA
Middle Name:SERA
Last Name:DANIEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21518 91ST AVE
Mailing Address - Street 2:
Mailing Address - City:QUEENS VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11428-1217
Mailing Address - Country:US
Mailing Address - Phone:718-217-0202
Mailing Address - Fax:718-217-0074
Practice Address - Street 1:21518 91ST AVE
Practice Address - Street 2:
Practice Address - City:QUEENS VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11428-1217
Practice Address - Country:US
Practice Address - Phone:718-217-0202
Practice Address - Fax:718-217-0074
Is Sole Proprietor?:No
Enumeration Date:2008-10-07
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY250040208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics