Provider Demographics
NPI:1760352389
Name:TABANSI, DANIEL UDEOZO (PMHNP)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:UDEOZO
Last Name:TABANSI
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 GADSEN PL
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-4806
Mailing Address - Country:US
Mailing Address - Phone:917-841-4506
Mailing Address - Fax:
Practice Address - Street 1:16 GADSEN PL
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-4806
Practice Address - Country:US
Practice Address - Phone:917-841-4506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-11-08
Last Update Date:2025-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY405615363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health