Individual
DANIELLE FAXON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3712 108TH ST, CORONA, NY 11368-2025
(718) 651-4000
Mailing address
3712 108TH ST, CORONA, NY 11368-2025
(718) 651-4000
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
036263
NY
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
07/02/2026
Last updated
08/12/2026
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