Healthcare Provider Details

I. General information

NPI: 1861882490
Provider Name (Legal Business Name): DANIA CODADA MSN, RN, PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2015
Last Update Date: 04/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1818 HAZEN ST
EAST ELMHURST NY
11370-1383
US

IV. Provider business mailing address

36 HILTON AVE APT 102
HEMPSTEAD NY
11550-2116
US

V. Phone/Fax

Practice location:
  • Phone: 212-442-3853
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number402539
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number69350
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: