MEDICARE: DANIELLE PEDDYCOART

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	363LF0000X	Family Nurse Practitioner	F349991-01	NY

General Provider Information

NPI Number	:	1619695475
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIELLE PEDDYCOART

Provider Business Mailing Address
First Line	:	5 BEACH RD
Second Line	:
City	:	MASSAPEQUA
State	:	NY
Zip	:	11758-6614
Country	:	US
Telephone Number	:	631-655-5255
Fax Number	:

Provider Business Practice Location Address
First Line	:	5 BEACH RD
Second Line	:
City	:	MASSAPEQUA
State	:	NY
Zip	:	11758-6614
Country	:	US
Telephone Number	:	631-655-5255
Fax Number	:

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

Provider Enumeration Date	:	08/18/2022
Last Update Date	:	08/18/2022

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Directions to “ DANIELLE PEDDYCOART ” Practice Location

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