Provider Demographics
NPI:1992285449
Name:DRISCOLL, DONNA (PHD, CPNP)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:DRISCOLL
Suffix:
Gender:F
Credentials:PHD, CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 FLAGSTONE LN
Mailing Address - Street 2:
Mailing Address - City:WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11590-6531
Mailing Address - Country:US
Mailing Address - Phone:516-455-1405
Mailing Address - Fax:516-333-3810
Practice Address - Street 1:167 E MERRICK RD
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580-5925
Practice Address - Country:US
Practice Address - Phone:516-825-3030
Practice Address - Fax:516-825-4282
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-15
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY380949-1363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics