Healthcare Provider Details

I. General information

NPI: 1801459698
Provider Name (Legal Business Name): DANIELLE SYPHER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2019
Last Update Date: 11/09/2023
Certification Date: 10/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11835 QUEENS BLVD LOWR LEVEL
FOREST HILLS NY
11375-7200
US

IV. Provider business mailing address

474 48TH AVE APT 32L
LONG ISLAND CITY NY
11109-5717
US

V. Phone/Fax

Practice location:
  • Phone: 718-408-4915
  • Fax: 718-744-2376
Mailing address:
  • Phone: 518-588-9817
  • 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: