MEDICARE: MS. DANIELLE DIFEDE PHYSICIAN ASSISTANT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	015951	NY

General Provider Information

NPI Number	:	1013257955
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DANIELLE DIFEDE PHYSICIAN ASSISTANT

Provider Business Mailing Address
First Line	:	6203 N HEMPSTEAD TPKE
Second Line	:
City	:	EAST NORWICH
State	:	NY
Zip	:	11732-1617
Country	:	US
Telephone Number	:	516-660-8361
Fax Number	:

Provider Business Practice Location Address
First Line	:	ONE GUSTAVE L. LEVY PLACE MOUNT SINAI HOSPITAL
Second Line	:	BOX 1116
City	:	NEW YORK
State	:	NY
Zip	:	10029-6574
Country	:	US
Telephone Number	:	212-824-8100
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/28/2013
Last Update Date	:	02/28/2013

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