Provider Demographics
NPI:1790176253
Name:CONDIA, DANIELLE ANGEL (MS ED)
Entity Type:Individual
Prefix:MS
First Name:DANIELLE
Middle Name:ANGEL
Last Name:CONDIA
Suffix:
Gender:F
Credentials:MS ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 ELIZABETH WAY
Mailing Address - Street 2:
Mailing Address - City:RIDGE
Mailing Address - State:NY
Mailing Address - Zip Code:11961-2953
Mailing Address - Country:US
Mailing Address - Phone:631-513-8989
Mailing Address - Fax:
Practice Address - Street 1:50 ELIZABETH WAY
Practice Address - Street 2:
Practice Address - City:RIDGE
Practice Address - State:NY
Practice Address - Zip Code:11961-2953
Practice Address - Country:US
Practice Address - Phone:631-513-8989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-05
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1075134174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist