Provider Demographics
NPI:1811328057
Name:HARRINGTON, DANIELLE SANDRA (PA)
Entity type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:SANDRA
Last Name:HARRINGTON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MS
Other - First Name:DANIELLE
Other - Middle Name:SANDRA
Other - Last Name:DUNHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:399 GRANT AVENUE RD
Mailing Address - Street 2:PO BOX 1339
Mailing Address - City:AUBURN
Mailing Address - State:NY
Mailing Address - Zip Code:13021-8202
Mailing Address - Country:US
Mailing Address - Phone:315-253-2669
Mailing Address - Fax:315-282-0077
Practice Address - Street 1:399 GRANT AVENUE RD
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-8202
Practice Address - Country:US
Practice Address - Phone:315-253-2669
Practice Address - Fax:315-282-0077
Is Sole Proprietor?:No
Enumeration Date:2013-12-12
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017191363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03768018Medicaid
NY03768018Medicaid