Healthcare Provider Details

I. General information

NPI: 1174447197
Provider Name (Legal Business Name): BIANCA DAUDELIN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 BEARTOWN RD
PAINTED POST NY
14870-9320
US

IV. Provider business mailing address

74 CAMPGROUND RD
BEAVER DAMS NY
14812-9382
US

V. Phone/Fax

Practice location:
  • Phone: 607-936-6514
  • Fax:
Mailing address:
  • Phone: 607-936-6514
  • Fax: 607-654-2798

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number688000-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: