Provider Demographics
NPI:1013257955
Name:DIFEDE, DANIELLE (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MS
First Name:DANIELLE
Middle Name:
Last Name:DIFEDE
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6203 N HEMPSTEAD TPKE
Mailing Address - Street 2:
Mailing Address - City:EAST NORWICH
Mailing Address - State:NY
Mailing Address - Zip Code:11732-1617
Mailing Address - Country:US
Mailing Address - Phone:516-660-8361
Mailing Address - Fax:
Practice Address - Street 1:ONE GUSTAVE L. LEVY PLACE MOUNT SINAI HOSPITAL
Practice Address - Street 2:BOX 1116
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-6574
Practice Address - Country:US
Practice Address - Phone:212-824-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-28
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015951363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant