Provider Demographics
NPI:1841307956
Name:LANDZINSKI, DANIELLE M (PA-C)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:M
Last Name:LANDZINSKI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:M
Other - Last Name:VILLANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:5004 PHEASANT RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-6215
Mailing Address - Country:US
Mailing Address - Phone:703-895-2310
Mailing Address - Fax:
Practice Address - Street 1:10615 JUDICIAL DR STE 401
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-7501
Practice Address - Country:US
Practice Address - Phone:571-295-6602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2020-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPA030493363AM0700X, 363AM0700X
VA0110002311363AM0700X
MDC0004522363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty