Healthcare Provider Details

I. General information

NPI: 1285644054
Provider Name (Legal Business Name): ANDREW CORNEL DALEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 07/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17913 BAHAMA ISLE DR
TAMPA FL
33647-2777
US

IV. Provider business mailing address

PO BOX 4707
PLANT CITY FL
33563-0030
US

V. Phone/Fax

Practice location:
  • Phone: 813-651-1085
  • Fax: 813-677-5690
Mailing address:
  • Phone: 813-651-1085
  • Fax: 813-677-5690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME92581
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: