Healthcare Provider Details

I. General information

NPI: 1568795359
Provider Name (Legal Business Name): DARYL DEANDRE MCCLENDON D.O
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2009
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

326 NICHOLS RD
FITCHBURG MA
01420-1914
US

IV. Provider business mailing address

326 NICHOLS ROAD COMMUNITY HEALTH CONNECTIONS
FITCHBURG MA
01420
US

V. Phone/Fax

Practice location:
  • Phone: 978-878-8100
  • Fax: 978-878-8535
Mailing address:
  • Phone: 978-878-8100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number53889
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number254774
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: