Healthcare Provider Details

I. General information

NPI: 1437688124
Provider Name (Legal Business Name): DANIELLE COMISSIONG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2017
Last Update Date: 10/13/2022
Certification Date: 10/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9149 ESTATE THOMAS
ST THOMAS VI
00802-2615
US

IV. Provider business mailing address

PO BOX 306813
ST THOMAS VI
00803-6813
US

V. Phone/Fax

Practice location:
  • Phone: 340-777-8520
  • Fax: 340-779-7256
Mailing address:
  • Phone: 340-777-8520
  • Fax: 340-779-7256

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number3343
License Number StateVI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: