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General NPI Number Information
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NPI Number | 1790714152
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Entity Type | Individual
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Provider Name | FRANK JOSEPH DAUGHERTY CRNA
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Gender | Male
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Dates
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Enumeration Date | 06/30/2006
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Last Update Date | 08/11/2022
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Provider Practice Location Address
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Address Line | 216 1ST ST
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City | MINEOLA
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State | NY
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Zip | 11501-3901
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Country | US
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Telephone | 516-663-2216
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Fax |
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Provider Business Mailing Address
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Address Line | 30 LITTLE NECK RD
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City | CENTERPORT
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State | NY
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Zip | 11721-1668
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Country | US
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Telephone | 631-239-1323
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Fax | 631-239-1323
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 407130
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License Number State | NY
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