Provider Demographics
NPI:1790714152
Name:DAUGHERTY, FRANK JOSEPH (CRNA)
Entity Type:Individual
Prefix:MR
First Name:FRANK
Middle Name:JOSEPH
Last Name:DAUGHERTY
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:30 LITTLE NECK RD
Mailing Address - Street 2:
Mailing Address - City:CENTERPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11721-1668
Mailing Address - Country:US
Mailing Address - Phone:631-239-1323
Mailing Address - Fax:631-239-1323
Practice Address - Street 1:216 1ST ST
Practice Address - Street 2:
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-3901
Practice Address - Country:US
Practice Address - Phone:516-663-2216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-30
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY407130367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY407130OtherLICENSE
NY11-3465690OtherTAX ID