Provider Demographics
NPI:1578147765
Name:RUSSO, DANIELLE ANNETTE (RN)
Entity Type:Individual
Prefix:MS
First Name:DANIELLE
Middle Name:ANNETTE
Last Name:RUSSO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:ANNETTE
Other - Last Name:PASINI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:17 QUEENS WAY
Mailing Address - Street 2:
Mailing Address - City:MAHOPAC
Mailing Address - State:NY
Mailing Address - Zip Code:10541-4437
Mailing Address - Country:US
Mailing Address - Phone:914-417-5475
Mailing Address - Fax:
Practice Address - Street 1:17 QUEENS WAY
Practice Address - Street 2:
Practice Address - City:MAHOPAC
Practice Address - State:NY
Practice Address - Zip Code:10541-4437
Practice Address - Country:US
Practice Address - Phone:914-417-5475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-12
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY352953-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse