Provider Demographics
NPI:1801966015
Name:D'ALLEVA-BYRNE, DANIELLE (PA)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:D'ALLEVA-BYRNE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270 UNION AVE
Mailing Address - Street 2:
Mailing Address - City:HOLBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11741-1823
Mailing Address - Country:US
Mailing Address - Phone:631-588-7973
Mailing Address - Fax:631-471-3039
Practice Address - Street 1:270 UNION AVE
Practice Address - Street 2:
Practice Address - City:HOLBROOK
Practice Address - State:NY
Practice Address - Zip Code:11741-1823
Practice Address - Country:US
Practice Address - Phone:631-588-7973
Practice Address - Fax:631-471-3039
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009506363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03296013Medicaid