Individual
ADRIENNE DATTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
475 SEAVIEW AVE, STATEN ISLAND, NY 10305-3436
(718) 226-9360
(718) 226-1128
Mailing address
165 PARK ROW APT 3D, NEW YORK, NY 10038-1104
(619) 201-4954
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
022626
NY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
08/06/2018
Last updated
10/17/2018
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