Healthcare Provider Details

I. General information

NPI: 1609641067
Provider Name (Legal Business Name): MR. MICHAEL JAMES DALY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2023
Last Update Date: 02/05/2024
Certification Date: 02/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6901 SIMMONS LOOP
RIVERVIEW FL
33578-9498
US

IV. Provider business mailing address

32419 TURTLE GRACE LOOP
WESLEY CHAPEL FL
33545-2338
US

V. Phone/Fax

Practice location:
  • Phone: 516-557-9487
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberRN9518042
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN11030970
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: