Individual
DANIELLE SOPHIA MIRABELLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
301 E MAIN ST, BAY SHORE, NY 11706
(631) 968-3000
Mailing address
1427 LAKESIDE DRIVE, WANTAGH, NY 11793
(516) 286-8377
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
029746-01
NY
363A00000X
Physician Assistant
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
11/21/2022
Last updated
05/18/2023
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