Healthcare Provider Details

I. General information

NPI: 1306074455
Provider Name (Legal Business Name): MARY DEALY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2009
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 NORFOLK RD
MILLIS MA
02054-1724
US

IV. Provider business mailing address

445 MAIN ST STE 180
MEDFIELD MA
02052-2066
US

V. Phone/Fax

Practice location:
  • Phone: 508-298-4824
  • Fax: 478-347-5816
Mailing address:
  • Phone: 508-216-0112
  • Fax: 478-347-5816

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number154016
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: