Individual
DANIELLE MEDIATE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
180 E PULASKI RD, HUNTINGTN STA, NY 11746-1915
(631) 425-2110
Mailing address
170 BROOKSITE DR, SMITHTOWN, NY 11787-4404
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
297671
NY
Other
Enumeration date
05/10/2023
Last updated
05/10/2023
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