Provider Demographics
NPI:1134546203
Name:FELICIANO, DAVID (MD,)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:FELICIANO
Suffix:
Gender:M
Credentials:MD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1918 COOLEY AVE
Mailing Address - Street 2:APT 8
Mailing Address - City:EAST PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94303-2473
Mailing Address - Country:US
Mailing Address - Phone:646-284-6037
Mailing Address - Fax:
Practice Address - Street 1:7901 BROADWAY RM E2-69
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-1329
Practice Address - Country:US
Practice Address - Phone:718-334-2883
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-26
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY295825207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology