Provider Demographics
NPI:1689020091
Name:DICLERICO, DANIELLA MARIA (FNP)
Entity Type:Individual
Prefix:
First Name:DANIELLA
Middle Name:MARIA
Last Name:DICLERICO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3108 HIGH RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:10598-2829
Mailing Address - Country:US
Mailing Address - Phone:914-497-2490
Mailing Address - Fax:
Practice Address - Street 1:35 E 62ND ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-8014
Practice Address - Country:US
Practice Address - Phone:212-572-5050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-05
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF340511-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily