Provider Demographics
NPI:1710720420
Name:PANICCIA, DANIELA
Entity type:Individual
Prefix:
First Name:DANIELA
Middle Name:
Last Name:PANICCIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 CLOVER CT
Mailing Address - Street 2:
Mailing Address - City:EAST NORWICH
Mailing Address - State:NY
Mailing Address - Zip Code:11732-1628
Mailing Address - Country:US
Mailing Address - Phone:516-660-7719
Mailing Address - Fax:
Practice Address - Street 1:6 CLOVER CT
Practice Address - Street 2:
Practice Address - City:EAST NORWICH
Practice Address - State:NY
Practice Address - Zip Code:11732-1628
Practice Address - Country:US
Practice Address - Phone:516-660-7719
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-18
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program