Healthcare Provider Details

I. General information

NPI: 1255597795
Provider Name (Legal Business Name): MACKENZIE DAILEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2008
Last Update Date: 02/17/2026
Certification Date: 02/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12983 SOUTHERN BLVD STE 100
LOXAHATCHEE FL
33470-9254
US

IV. Provider business mailing address

12983 SOUTHERN BLVD STE 100
LOXAHATCHEE FL
33470-9254
US

V. Phone/Fax

Practice location:
  • Phone: 561-793-2500
  • Fax: 561-793-2510
Mailing address:
  • Phone: 561-793-2500
  • Fax: 561-793-2510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number125051993
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME105166
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: