Provider Demographics
NPI:1043588650
Name:MAUCIERI, DANIELLE NICOLE (PA)
Entity type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:NICOLE
Last Name:MAUCIERI
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 GLEASON PL
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:NY
Mailing Address - Zip Code:10528-4603
Mailing Address - Country:US
Mailing Address - Phone:914-497-9578
Mailing Address - Fax:
Practice Address - Street 1:17 GLEASON PL
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:NY
Practice Address - Zip Code:10528-4603
Practice Address - Country:US
Practice Address - Phone:914-497-9578
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-09
Last Update Date:2016-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015350363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant