Healthcare Provider Details

I. General information

NPI: 1023797032
Provider Name (Legal Business Name): DANIELA CHICAIZA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2023
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 BLUE POINT AVE UNIT A
BLUE POINT NY
11715-1261
US

IV. Provider business mailing address

425 CENTRE AVE
LINDENHURST NY
11757-3916
US

V. Phone/Fax

Practice location:
  • Phone: 631-363-5794
  • Fax:
Mailing address:
  • Phone: 516-388-4753
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: