Provider Demographics
NPI:1538416805
Name:CAMENZULI, DANIELLE BRITTANY
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:BRITTANY
Last Name:CAMENZULI
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 1:20 TRESCOTT PATH
Mailing Address - Street 2:
Mailing Address - City:FORT SALONGA
Mailing Address - State:NY
Mailing Address - Zip Code:11768-2538
Mailing Address - Country:US
Mailing Address - Phone:631-965-7233
Mailing Address - Fax:718-409-5901
Practice Address - Street 1:6 PENNYFIELD AVENUE
Practice Address - Street 2:SUNY MARITIME COLLEGE HEALTH SERVICES
Practice Address - City:THROGGS NECK
Practice Address - State:NY
Practice Address - Zip Code:10465-2612
Practice Address - Country:US
Practice Address - Phone:718-409-5424
Practice Address - Fax:718-409-5901
Is Sole Proprietor?:No
Enumeration Date:2012-08-06
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015701-1363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical