Individual provider Active NPI

Danielle Marie Cavanaugh, PA-C

  • Physician Assistant
  • Glens Falls, NY
National Provider Identifier
1730744608
Registry record updated May 23, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
024349 Issued in NY
Practice address
100 Broad St
Glens Falls, NY 12801-4349
Phone
(518) 792-2223
Fax
(518) 792-8231
NPI assigned
May 7, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 23, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 024349 NY Primary

Addresses

Primary practice location

100 Broad St
Glens Falls, NY 12801-4349

Mailing address

9 Carey Rd
Queensbury, NY 12804-7880
Phone (518) 761-0300

Other practice location 1

3767 Main Street
Warrensburg, NY 12885-1890
Phone (518) 623-2844

Other identifiers 1

IdentifierTypeStateIssuer
05930130MedicaidNY

Other names 1

  • Danielle Marie Tetreault Former name

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address danielle.cavanaugh.1@1823.direct.athenahealth.com
Direct Messaging Address danielle.cavanaugh.1@1823.direct.athenahealth.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20191116000153 NY Practitioner - Physician Assistant 8022440825 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Hudson Headwaters Health NetworkGroup PAC ID 7416861208, 221 clinicians

Practice addresses (Care Compare)

100 Broad St
Glens Falls, NY 12801-4349
Phone (518) 792-2223

161 Carey Rd
Queensbury, NY 12804-7821
Phone (518) 824-8610

24 Fairfield Ave
Schroon Lake, NY 12870-0292
Phone (518) 532-7120

48 E St
Fort Edward, NY 12828-1811
Phone (518) 824-8630

Hospital & facility affiliations

  • Glens Falls Hospital Hospital, Glens Falls, NY, CCN 330191

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
024349NYMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Hudson Headwaters Health Network Physician Assistant CurrentSince Jul 27, 2020 Accepting new patients
Hudson Headwaters Health Network Physician Assistant CurrentSince Jul 27, 2020 Accepting new patients

Locations

100 Broad St
Glens Falls, NY 12801
Phone (518) 792-2223

9 Carey Rd
Queensbury, NY 12804

3767 Main St
Warrensburg, NY 12885
Phone (518) 623-2844

Interoperability endpoints

  • Direct secure messaging: danielle.cavanaugh.1@1823.direct.athenahealth.com

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1557187200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1747958400000",
    "number": "1730744608",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9 CAREY RD",
            "city": "QUEENSBURY",
            "state": "NY",
            "postal_code": "128047880",
            "telephone_number": "518-761-0300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 BROAD ST",
            "city": "GLENS FALLS",
            "state": "NY",
            "postal_code": "128014349",
            "telephone_number": "518-792-2223",
            "fax_number": "518-792-8231"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3767 Main Street",
            "address_purpose": "LOCATION",
            "city": "Warrensburg",
            "state": "NY",
            "postal_code": "128851890",
            "country_code": "US",
            "telephone_number": "518-623-2844",
            "fax_number": "518-623-3416",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CAVANAUGH",
        "first_name": "DANIELLE",
        "middle_name": "MARIE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-05-07",
        "last_updated": "2025-05-23",
        "certification_date": "2025-05-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "024349",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "05930130",
            "state": "NY"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "danielle.cavanaugh.1@1823.direct.athenahealth.com",
            "affiliation": "N",
            "address_1": "100 Broad St",
            "city": "Glens Falls",
            "state": "NY",
            "country_code": "US",
            "postal_code": "128014349",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "danielle.cavanaugh.1@1823.direct.athenahealth.com",
            "affiliation": "N",
            "address_1": "3767 Main Street",
            "city": "Warrensburg",
            "state": "NY",
            "country_code": "US",
            "postal_code": "128851890",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "DANIELLE",
            "last_name": "TETREAULT",
            "middle_name": "MARIE",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Glens Falls, NY

Sources for this page

Verify at the official NPI Registry.