Provider Demographics
NPI:1891482550
Name:PAVONE, DANIELLE DIANE DISALVO (CNM)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:DIANE DISALVO
Last Name:PAVONE
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 ELMWOOD AVE BOX 668
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-0001
Mailing Address - Country:US
Mailing Address - Phone:585-602-0440
Mailing Address - Fax:
Practice Address - Street 1:800 AYRAULT RD STE 100
Practice Address - Street 2:
Practice Address - City:FAIRPORT
Practice Address - State:NY
Practice Address - Zip Code:14450-8941
Practice Address - Country:US
Practice Address - Phone:585-602-0440
Practice Address - Fax:585-341-8381
Is Sole Proprietor?:No
Enumeration Date:2023-04-21
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY744843163W00000X
NY002207176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No163W00000XNursing Service ProvidersRegistered Nurse