Provider Demographics
NPI:1750052999
Name:DAIDONE, TESSA (PA)
Entity Type:Individual
Prefix:
First Name:TESSA
Middle Name:
Last Name:DAIDONE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 HOPE ST
Mailing Address - Street 2:
Mailing Address - City:NUTLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07110-3120
Mailing Address - Country:US
Mailing Address - Phone:862-571-0414
Mailing Address - Fax:
Practice Address - Street 1:36 HOPE ST
Practice Address - Street 2:
Practice Address - City:NUTLEY
Practice Address - State:NJ
Practice Address - Zip Code:07110-3120
Practice Address - Country:US
Practice Address - Phone:862-571-0414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-27
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical