Provider Demographics
NPI:1497310437
Name:ACKLEY, DANIELLE ELIZABETH FAIVUS (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIELLE
Middle Name:ELIZABETH FAIVUS
Last Name:ACKLEY
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 1:2257 CONNELL TER
Mailing Address - Street 2:
Mailing Address - City:BALDWINSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13027-1030
Mailing Address - Country:US
Mailing Address - Phone:315-532-4569
Mailing Address - Fax:
Practice Address - Street 1:601 ELMWOOD AVENUE BOX #777R
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14642-0001
Practice Address - Country:US
Practice Address - Phone:585-275-4174
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-06
Last Update Date:2019-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program