MEDICARE: KHADIJA DANIELS PA-C

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	C0006705	MD
2	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1336642883
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KHADIJA DANIELS PA-C

Provider Business Mailing Address
First Line	:	6201 GREENLEIGH AVE
Second Line	:
City	:	MIDDLE RIVER
State	:	MD
Zip	:	21220-2004
Country	:	US
Telephone Number	:	410-933-0000
Fax Number	:	410-500-4266

Provider Business Practice Location Address
First Line	:	150 55TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11220-2508
Country	:	US
Telephone Number	:	718-630-7000
Fax Number	:

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

Provider Enumeration Date	:	03/12/2018
Last Update Date	:	12/12/2025

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Directions to “ KHADIJA DANIELS PA-C” Practice Location

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