Provider Demographics
NPI:1992843908
Name:NETHERCOTT, DAYNA (PA)
Entity Type:Individual
Prefix:MRS
First Name:DAYNA
Middle Name:
Last Name:NETHERCOTT
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 NEWTOWN RD
Mailing Address - Street 2:SUITE 1D
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-4146
Mailing Address - Country:US
Mailing Address - Phone:203-790-0822
Mailing Address - Fax:203-790-1808
Practice Address - Street 1:107 NEWTOWN RD
Practice Address - Street 2:SUITE 1D
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-4146
Practice Address - Country:US
Practice Address - Phone:203-790-0822
Practice Address - Fax:203-790-1808
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011577363A00000X
CT002129363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant