Provider Demographics
NPI:1629494216
Name:COYNE, DANIALLE R (NP)
Entity Type:Individual
Prefix:
First Name:DANIALLE
Middle Name:R
Last Name:COYNE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:DANIALLE
Other - Middle Name:R
Other - Last Name:CALAUSTRO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:PO BOX 28082
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10087-8082
Mailing Address - Country:US
Mailing Address - Phone:212-731-3100
Mailing Address - Fax:
Practice Address - Street 1:17 E 102ND ST FL 4
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-5204
Practice Address - Country:US
Practice Address - Phone:212-659-8552
Practice Address - Fax:212-426-0349
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-06
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF307184363LA2200X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04177262Medicaid