Basic Information
Provider Information
NPI: 1568852549
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DUQUESNAY
FirstName: DANIELLE
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: PAC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 4302 ALTON RD
Address2: SUITE 830
City: MIAMI BEACH
State: FL
PostalCode: 331402891
CountryCode: US
TelephoneNumber: 3056742950
FaxNumber: 3056742749
Practice Location
Address1: 4302 ALTON RD
Address2: SUITE 830
City: MIAMI BEACH
State: FL
PostalCode: 331402891
CountryCode: US
TelephoneNumber: 3056742950
FaxNumber: 3056742749
Other Information
ProviderEnumerationDate: 01/29/2015
LastUpdateDate: 01/29/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363AM0700XPA9108492FLY Physician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical

No ID Information.


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