Healthcare Provider Details

I. General information

NPI: 1932744430
Provider Name (Legal Business Name): DANA ASHLI GALE LYTTLE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2019
Last Update Date: 11/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1727 AMSTERDAM AVE
NEW YORK NY
10031-4611
US

IV. Provider business mailing address

11639 217TH ST
CAMBRIA HEIGHTS NY
11411-1501
US

V. Phone/Fax

Practice location:
  • Phone: 646-340-1484
  • Fax:
Mailing address:
  • Phone: 347-869-1893
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number10814701
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: