MEDICARE: PEDDYCOART NP IN FAMILY HEALTHP 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	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1831048982
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEDDYCOART NP IN FAMILY HEALTHP C

Provider Business Mailing Address
First Line	:	5 BEACHRD
Second Line	:
City	:	MASSAPEUQA
State	:	NY
Zip	:	11758
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	:	NP
Name	:	MS. DANIELLE PEDDYCOART
Credential	:	NP
Telephone Number	:	631-655-5255

Provider Enumeration Date	:	01/22/2026
Last Update Date	:	01/22/2026

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