Basic Information
| Provider Information | |||||||||
| NPI: | 1053419333 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ROBBINS | ||||||||
| FirstName: | DANIELLE | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2140 MENDON RD | ||||||||
| Address2: | |||||||||
| City: | CUMBERLAND | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028643843 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4014753000 | ||||||||
| FaxNumber: | 4014753204 | ||||||||
| Practice Location | |||||||||
| Address1: | 351 N FRONTAGE RD | ||||||||
| Address2: | |||||||||
| City: | NEW LONDON | ||||||||
| State: | CT | ||||||||
| PostalCode: | 063202628 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8608650934 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2006 | ||||||||
| LastUpdateDate: | 01/09/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/09/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | PA00416 | RI | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
ID Information
| ID | Type | State | Issuer | Description | 4075 | 01 | CT | CT LICENSE | OTHER | PA00416 | 01 | RI | LICENSE | OTHER |