Provider Demographics
NPI:1902223381
Name:ROSS, DANIELLE S (PMH DNP)
Entity Type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:S
Last Name:ROSS
Suffix:
Gender:F
Credentials:PMH DNP
Other - Prefix:MS
Other - First Name:DANIELLE
Other - Middle Name:S
Other - Last Name:KENNELLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PMH DNP
Mailing Address - Street 1:33 CHURCH ST STE 3
Mailing Address - Street 2:
Mailing Address - City:FREDONIA
Mailing Address - State:NY
Mailing Address - Zip Code:14063-1761
Mailing Address - Country:US
Mailing Address - Phone:716-785-6335
Mailing Address - Fax:716-785-6138
Practice Address - Street 1:33 CHURCH ST STE 3
Practice Address - Street 2:
Practice Address - City:FREDONIA
Practice Address - State:NY
Practice Address - Zip Code:14063-1761
Practice Address - Country:US
Practice Address - Phone:716-785-6335
Practice Address - Fax:716-785-6138
Is Sole Proprietor?:No
Enumeration Date:2014-03-24
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY631965-1163WP0808X
NY401762363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03938281Medicaid