Individual
DANIELLE HEATHER RICCIARDO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
153 MOHAWK AVE, DEER PARK, NY 11729-1701
(631) 416-1989
Mailing address
153 MOHAWK AVE, DEER PARK, NY 11729-1701
(631) 416-1989
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
330415
NY
Other
Enumeration date
01/22/2018
Last updated
01/22/2018
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