Healthcare Provider Details

I. General information

NPI: 1477059384
Provider Name (Legal Business Name): DANIEL D FERNANDEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2018
Last Update Date: 08/19/2021
Certification Date: 08/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 NEW SCOTLAND RD STE 203
SLINGERLANDS NY
12159-9386
US

IV. Provider business mailing address

1220 NEW SCOTLAND RD STE 203
SLINGERLANDS NY
12159-9386
US

V. Phone/Fax

Practice location:
  • Phone: 518-439-2273
  • Fax:
Mailing address:
  • Phone: 518-439-2273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number312502
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: