Provider Demographics
NPI:1326545799
Name:BADOLATO, DANIELLE (NP)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:BADOLATO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 GLOVER DR
Mailing Address - Street 2:
Mailing Address - City:REVERE
Mailing Address - State:MA
Mailing Address - Zip Code:02151-4914
Mailing Address - Country:US
Mailing Address - Phone:339-927-2366
Mailing Address - Fax:
Practice Address - Street 1:45 GLOVER DR
Practice Address - Street 2:
Practice Address - City:REVERE
Practice Address - State:MA
Practice Address - Zip Code:02151-4914
Practice Address - Country:US
Practice Address - Phone:339-927-2366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-11
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAAG04180010363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health