Healthcare Provider Details

I. General information

NPI: 1912485020
Provider Name (Legal Business Name): DANIELLE ILANA PELLMAN RPA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2018
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 LAFAYETTE PL
GREENWICH CT
06830-5437
US

IV. Provider business mailing address

77 LAFAYETTE PL
GREENWICH CT
06830-5437
US

V. Phone/Fax

Practice location:
  • Phone: 203-863-4250
  • Fax: 203-863-4249
Mailing address:
  • Phone: 203-863-4250
  • Fax: 203-863-4249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number6115
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: