# MRS. LYDIE-DANIELLE FREDERIC

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1104160753
- **Gender:** F
- **Credential:** PA-C

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363A00000X | Physician Assistant | 0110010195 | VA | Yes |
| 363A00000X | Physician Assistant | 016255 | NY | — |
| 363A00000X | Physician Assistant | 25MP00345300 | NJ | — |

## Other

- **Enumeration date:** 11/20/2012
- **Last updated:** 01/06/2025