Provider Demographics
NPI:1457036964
Name:MCINTOSH, DANIELLA SHEMEKA
Entity Type:Individual
Prefix:
First Name:DANIELLA
Middle Name:SHEMEKA
Last Name:MCINTOSH
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 1:431 E 146TH ST # 1A
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10455-4101
Mailing Address - Country:US
Mailing Address - Phone:646-241-6806
Mailing Address - Fax:
Practice Address - Street 1:431 E 146TH ST # 1A
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10455-4101
Practice Address - Country:US
Practice Address - Phone:646-241-6806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-21
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY333718-01164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse