Healthcare Provider Details

I. General information

NPI: 1376270710
Provider Name (Legal Business Name): HALEY DYLAG PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HALEY BURGMYER PA

II. Dates (important events)

Enumeration Date: 08/05/2022
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

759 CHESTNUT STREET
SPRINGFIELD MA
01107-1619
US

IV. Provider business mailing address

280 CHESTNUT ST FL 2
SPRINGFIELD MA
01199-1001
US

V. Phone/Fax

Practice location:
  • Phone: 413-794-5161
  • Fax:
Mailing address:
  • Phone: 413-794-5700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA9022
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5769
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMSC002611J
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: