Provider Demographics
NPI:1851534887
Name:FERNANDEZ, DANIELLE (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8529 114TH ST
Mailing Address - Street 2:APARTMENT 2A
Mailing Address - City:RICHMOND HILL
Mailing Address - State:NY
Mailing Address - Zip Code:11418-1359
Mailing Address - Country:US
Mailing Address - Phone:917-257-0652
Mailing Address - Fax:
Practice Address - Street 1:8529 114TH ST
Practice Address - Street 2:APARTMENT 2A
Practice Address - City:RICHMOND HILL
Practice Address - State:NY
Practice Address - Zip Code:11418-1359
Practice Address - Country:US
Practice Address - Phone:917-257-0652
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-07
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016039-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist