Provider Demographics
NPI:1053419333
Name:ROBBINS, DANIELLE J (PA)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:J
Last Name:ROBBINS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2140 MENDON RD
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:RI
Mailing Address - Zip Code:02864-3843
Mailing Address - Country:US
Mailing Address - Phone:401-475-3000
Mailing Address - Fax:401-475-3204
Practice Address - Street 1:351 N FRONTAGE RD
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:CT
Practice Address - Zip Code:06320-2628
Practice Address - Country:US
Practice Address - Phone:860-865-0934
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPA00416363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT4075OtherCT LICENSE
RIPA00416OtherLICENSE