MEDICARE: DANIELLE AMISANO DO

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	207Q00000X	Family Medicine Physician	305103	NY

General Provider Information

NPI Number	:	1164951539
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIELLE AMISANO DO

Provider Business Mailing Address
First Line	:	500 COMMACK RD UNIT 150D
Second Line	:
City	:	COMMACK
State	:	NY
Zip	:	11725-5009
Country	:	US
Telephone Number	:	631-864-4499
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 COMMACK RD UNIT 150D
Second Line	:
City	:	COMMACK
State	:	NY
Zip	:	11725-5009
Country	:	US
Telephone Number	:	318-644-4996
Fax Number	:

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

Provider Enumeration Date	:	06/08/2017
Last Update Date	:	02/16/2022

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Directions to “ DANIELLE AMISANO DO” Practice Location

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