Provider Demographics
NPI:1962756015
Name:MCLOUGHLIN, DANIELLE (ANP)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:MCLOUGHLIN
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:
Other - Last Name:SHORTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ANP
Mailing Address - Street 1:119 CLEARMEADOW DR
Mailing Address - Street 2:
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-1223
Mailing Address - Country:US
Mailing Address - Phone:516-567-1654
Mailing Address - Fax:
Practice Address - Street 1:119 CLEARMEADOW DR
Practice Address - Street 2:
Practice Address - City:EAST MEADOW
Practice Address - State:NY
Practice Address - Zip Code:11554-1223
Practice Address - Country:US
Practice Address - Phone:516-567-1654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-28
Last Update Date:2012-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF306220-1363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF306220-1OtherLICENSE