Provider Demographics
NPI:1023326683
Name:HALEM, DANIELLE SHANA (LAC)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:SHANA
Last Name:HALEM
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1135 WALT WHITMAN RD
Mailing Address - Street 2:#27A
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-2826
Mailing Address - Country:US
Mailing Address - Phone:631-683-4796
Mailing Address - Fax:
Practice Address - Street 1:1135 WALT WHITMAN RD
Practice Address - Street 2:#27A
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-2826
Practice Address - Country:US
Practice Address - Phone:631-683-4796
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-16
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013884363A00000X
NY25 005746171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant