MEDICARE: DANIELLE MARIE LEE PA-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	363A00000X	Physician Assistant	PA9117381	FL

General Provider Information

NPI Number	:	1407545254
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIELLE MARIE LEE PA-C

Provider Business Mailing Address
First Line	:	PO BOX 22239
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10087-0001
Country	:	US
Telephone Number	:	702-899-0595
Fax Number	:	702-977-1496

Provider Business Practice Location Address
First Line	:	4847 DAVID S MACK DR
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33417-8023
Country	:	US
Telephone Number	:	872-231-3162
Fax Number	:

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

Provider Enumeration Date	:	05/05/2023
Last Update Date	:	03/18/2026

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