Provider Demographics
NPI:1457974180
Name:URSUA, DANIELLYNN ANNE BERNALES
Entity Type:Individual
Prefix:
First Name:DANIELLYNN
Middle Name:ANNE BERNALES
Last Name:URSUA
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 1:330A PULASKI AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10303-2632
Mailing Address - Country:US
Mailing Address - Phone:347-684-9675
Mailing Address - Fax:
Practice Address - Street 1:100 CASTLETON AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10301-3004
Practice Address - Country:US
Practice Address - Phone:718-273-1300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-28
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3295371-01164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse