Provider Demographics
NPI:1295475036
Name:FISENNE, DANIELLE THERESA (MD)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:THERESA
Last Name:FISENNE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 BROADHOLLOW RD STE 150
Mailing Address - Street 2:
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-4909
Mailing Address - Country:US
Mailing Address - Phone:631-386-4100
Mailing Address - Fax:
Practice Address - Street 1:100 MANETTO HILL RD STE 302
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-1311
Practice Address - Country:US
Practice Address - Phone:516-931-7337
Practice Address - Fax:516-931-7444
Is Sole Proprietor?:No
Enumeration Date:2022-03-30
Last Update Date:2025-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY336022208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics