Provider Demographics
NPI:1265252019
Name:VANDALEY, DANIELLE ANN
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:ANN
Last Name:VANDALEY
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 1:770 JACKSON ST APT 1122
Mailing Address - Street 2:
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-6979
Mailing Address - Country:US
Mailing Address - Phone:917-578-6950
Mailing Address - Fax:
Practice Address - Street 1:770 JACKSON ST APT 1122
Practice Address - Street 2:
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-6979
Practice Address - Country:US
Practice Address - Phone:917-578-6950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-16
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY355045363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty