Healthcare Provider Details

I. General information

NPI: 1245211721
Provider Name (Legal Business Name): MIRI DALY DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2005
Last Update Date: 05/16/2023
Certification Date: 05/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 HAZARD AVE SUITE B
ENFIELD CT
06082-5443
US

IV. Provider business mailing address

141 HAZARD AVE SUITE B
ENFIELD CT
06082-5412
US

V. Phone/Fax

Practice location:
  • Phone: 860-272-2930
  • Fax: 860-272-2937
Mailing address:
  • Phone: 860-272-2930
  • Fax: 860-272-2937

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number03-668583
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number03-668583
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number521
License Number StateCT
# 4
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number000521
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: