Provider Demographics
NPI:1124625074
Name:DAMAS, DANIELLE
Entity type:Individual
Prefix:MISS
First Name:DANIELLE
Middle Name:
Last Name:DAMAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 E SUNRISE HWY STE 500
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11581-1233
Mailing Address - Country:US
Mailing Address - Phone:516-355-1230
Mailing Address - Fax:949-437-8376
Practice Address - Street 1:70 E SUNRISE HWY STE 500
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11581-1233
Practice Address - Country:US
Practice Address - Phone:516-355-1230
Practice Address - Fax:949-437-8376
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-05
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY403233364SP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental HealthGroup - Single Specialty