Provider Demographics
NPI:1710336516
Name:MAHER, DANIELLE (MS)
Entity Type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:
Last Name:MAHER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MS
Other - First Name:DANIELLE
Other - Middle Name:
Other - Last Name:VIDIRI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:22 RICHLEE DR
Mailing Address - Street 2:
Mailing Address - City:EAST NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11731-4625
Mailing Address - Country:US
Mailing Address - Phone:631-897-9388
Mailing Address - Fax:
Practice Address - Street 1:299 HALLOCK AVE
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON STATION
Practice Address - State:NY
Practice Address - Zip Code:11776-1217
Practice Address - Country:US
Practice Address - Phone:631-473-4284
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-13
Last Update Date:2016-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist