Provider Demographics
NPI:1538157722
Name:BAKER, DANIELLE M (PA-C)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:M
Last Name:BAKER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 CAREY RD
Mailing Address - Street 2:
Mailing Address - City:QUEENSBURY
Mailing Address - State:NY
Mailing Address - Zip Code:12804-7880
Mailing Address - Country:US
Mailing Address - Phone:518-761-0300
Mailing Address - Fax:518-824-2388
Practice Address - Street 1:28 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:QUEENSBURY
Practice Address - State:NY
Practice Address - Zip Code:12804-3323
Practice Address - Country:US
Practice Address - Phone:518-798-6400
Practice Address - Fax:518-798-4105
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2025-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010230363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02650333Medicaid
NY5998826OtherGHI
NY000415826001OtherBSNENY
PA0518Medicare ID - Type Unspecified
NY5998826OtherGHI