Healthcare Provider Details

I. General information

NPI: 1336073436
Provider Name (Legal Business Name): NICOLE DALEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5555 W BLUE HERON BLVD
RIVIERA BEACH FL
33418-7815
US

IV. Provider business mailing address

880 CAIN DR
WIGGINS MS
39577-8761
US

V. Phone/Fax

Practice location:
  • Phone: 561-840-0754
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA22358
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: