MEDICARE: MISS DANIELLE FAYE STOEBE RPA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	010778	NY
2	363A00000X	Physician Assistant	010778	NY

General Provider Information

NPI Number	:	1033258009
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS DANIELLE FAYE STOEBE RPA-C

Provider Business Mailing Address
First Line	:	185 OLD COUNTRY RD
Second Line	:	SUITE 2
City	:	RIVERHEAD
State	:	NY
Zip	:	11901-2121
Country	:	US
Telephone Number	:	631-298-4479
Fax Number	:	631-591-3047

Provider Business Practice Location Address
First Line	:	54 WOODVILLE RD
Second Line	:
City	:	SHOREHAM
State	:	NY
Zip	:	11786-1331
Country	:	US
Telephone Number	:	631-929-1256
Fax Number	:	631-929-8313

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/06/2007
Last Update Date	:	04/21/2015

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Directions to “ MISS DANIELLE FAYE STOEBE RPA-C” Practice Location

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