MEDICARE: SEAN DALY D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	2085R0202X	Diagnostic Radiology Physician	2022-00374	NC

General Provider Information

NPI Number	:	1932632304
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SEAN DALY D.O.

Provider Business Mailing Address
First Line	:	3100 N TENAYA WAY
Second Line	:	GRADUATE MEDICAL EDUCATION
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-0431
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3100 N TENAYA WAY
Second Line	:	GRADUATE MEDICAL EDUCATION
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-0431
Country	:	US
Telephone Number	:	702-962-9546
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/04/2017
Last Update Date	:	08/07/2022

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