Healthcare Provider Details

I. General information

NPI: 1750108502
Provider Name (Legal Business Name): MRS. MICHELLE DANCA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2024
Last Update Date: 09/23/2024
Certification Date: 09/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 JERICHO TPKE
SYOSSET NY
11791-4515
US

IV. Provider business mailing address

89 GREGORY AVE
MERRICK NY
11566-4217
US

V. Phone/Fax

Practice location:
  • Phone: 516-496-6400
  • Fax:
Mailing address:
  • Phone: 516-712-5986
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number12865139
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number718965
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: