Provider Demographics
NPI:1912485020
Name:PELLMAN, DANIELLE ILANA (RPA)
Entity Type:Individual
Prefix:MISS
First Name:DANIELLE
Middle Name:ILANA
Last Name:PELLMAN
Suffix:
Gender:F
Credentials:RPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:777 N BROADWAY STE 207
Mailing Address - Street 2:
Mailing Address - City:SLEEPY HOLLOW
Mailing Address - State:NY
Mailing Address - Zip Code:10591-1019
Mailing Address - Country:US
Mailing Address - Phone:914-269-1870
Mailing Address - Fax:914-269-1868
Practice Address - Street 1:777 N BROADWAY STE 207
Practice Address - Street 2:
Practice Address - City:SLEEPY HOLLOW
Practice Address - State:NY
Practice Address - Zip Code:10591-1019
Practice Address - Country:US
Practice Address - Phone:914-269-1870
Practice Address - Fax:914-269-1868
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-31
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0243314363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant