Healthcare Provider Details

I. General information

NPI: 1851578363
Provider Name (Legal Business Name): ELIZABETH O DANIA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2008
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2015 GRAND CONCOURSE
BRONX NY
10453-4303
US

IV. Provider business mailing address

19115 115TH AVE
SAINT ALBANS NY
11412-2727
US

V. Phone/Fax

Practice location:
  • Phone: 718-583-7736
  • Fax: 347-479-1303
Mailing address:
  • Phone: 917-500-0671
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number306005
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number401729
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number585848
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: