Provider Demographics
NPI:1902399108
Name:WEEKES, DANIELLE GENEVA (MD)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:GENEVA
Last Name:WEEKES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 GERVISTON CT
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13090-3911
Mailing Address - Country:US
Mailing Address - Phone:315-278-7197
Mailing Address - Fax:
Practice Address - Street 1:6800 E GENESEE ST STE 1501
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NY
Practice Address - Zip Code:13066-1097
Practice Address - Country:US
Practice Address - Phone:315-445-0003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-12
Last Update Date:2021-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY311331208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program