Provider Demographics
NPI:1215651898
Name:DANTON, JULIE MICHELLE (174400000X)
Entity type:Individual
Prefix:MISS
First Name:JULIE
Middle Name:MICHELLE
Last Name:DANTON
Suffix:
Gender:F
Credentials:174400000X
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14379 US ROUTE 9W
Mailing Address - Street 2:
Mailing Address - City:RAVENA
Mailing Address - State:NY
Mailing Address - Zip Code:12143-3103
Mailing Address - Country:US
Mailing Address - Phone:518-756-3124
Mailing Address - Fax:
Practice Address - Street 1:14379 US ROUTE 9W
Practice Address - Street 2:
Practice Address - City:RAVENA
Practice Address - State:NY
Practice Address - Zip Code:12143-3103
Practice Address - Country:US
Practice Address - Phone:518-756-3124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-28
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist