Provider Demographics
NPI:1558126623
Name:GOODENOW, DANIELLE LEE (PA)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:LEE
Last Name:GOODENOW
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:54 RED JACKET PKWY
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14220-2011
Mailing Address - Country:US
Mailing Address - Phone:585-770-4031
Mailing Address - Fax:
Practice Address - Street 1:4827 TRANSIT RD
Practice Address - Street 2:
Practice Address - City:DEPEW
Practice Address - State:NY
Practice Address - Zip Code:14043-4788
Practice Address - Country:US
Practice Address - Phone:716-608-2236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-19
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant