Provider Demographics
NPI:1255998738
Name:VANDERSTAR, DANIELLE LAUREN
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:LAUREN
Last Name:VANDERSTAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 143
Mailing Address - Street 2:
Mailing Address - City:SUGAR LOAF
Mailing Address - State:NY
Mailing Address - Zip Code:10981-0143
Mailing Address - Country:US
Mailing Address - Phone:718-869-1683
Mailing Address - Fax:
Practice Address - Street 1:87 E MAIN ST # 1
Practice Address - Street 2:
Practice Address - City:WASHINGTONVILLE
Practice Address - State:NY
Practice Address - Zip Code:10992-1279
Practice Address - Country:US
Practice Address - Phone:845-495-0517
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-21
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist