Healthcare Provider Details

I. General information

NPI: 1215758131
Provider Name (Legal Business Name): DANIELLE ELIZABETH DOUGHERTY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2024
Last Update Date: 10/23/2024
Certification Date: 10/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 KINGS HIGHWAY CUTOFF
FAIRFIELD CT
06824-5340
US

IV. Provider business mailing address

4550 PRESTWICK DR
READING PA
19606-8909
US

V. Phone/Fax

Practice location:
  • Phone: 877-925-3637
  • Fax: 203-333-3937
Mailing address:
  • Phone: 484-336-3217
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: