Provider Demographics
NPI:1881930667
Name:COLBERT, DANIELLE D (TEACHER)
Entity type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:D
Last Name:COLBERT
Suffix:
Gender:F
Credentials:TEACHER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2827 COVERED BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-4818
Mailing Address - Country:US
Mailing Address - Phone:516-223-6477
Mailing Address - Fax:516-868-7208
Practice Address - Street 1:2827 COVERED BRIDGE RD
Practice Address - Street 2:
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566-4818
Practice Address - Country:US
Practice Address - Phone:516-223-6477
Practice Address - Fax:516-868-7208
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-23
Last Update Date:2012-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor