Provider Demographics
NPI:1952380016
Name:BELLUMORI, DANIELLE ANNETTE (NP)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:ANNETTE
Last Name:BELLUMORI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:ANNETTE
Other - Last Name:DONNINI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:82 COPELAND AVE
Mailing Address - Street 2:
Mailing Address - City:HOMER
Mailing Address - State:NY
Mailing Address - Zip Code:13077-1528
Mailing Address - Country:US
Mailing Address - Phone:607-749-2640
Mailing Address - Fax:607-749-2644
Practice Address - Street 1:82 COPELAND AVE
Practice Address - Street 2:
Practice Address - City:HOMER
Practice Address - State:NY
Practice Address - Zip Code:13077-1528
Practice Address - Country:US
Practice Address - Phone:607-749-2640
Practice Address - Fax:607-749-2644
Is Sole Proprietor?:No
Enumeration Date:2006-01-16
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF340546-1363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02387828Medicaid
NYP68452Medicare UPIN
NYDD2461Medicare ID - Type Unspecified
NYJ400066121Medicare PIN