Healthcare Provider Details

I. General information

NPI: 1194262337
Provider Name (Legal Business Name): TYLER DELANEY ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2017
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

716 STEVENS AVE
PORTLAND ME
04103-2693
US

IV. Provider business mailing address

133A RAMSDELL RD
GRAY ME
04039-7765
US

V. Phone/Fax

Practice location:
  • Phone: 207-221-4545
  • Fax:
Mailing address:
  • Phone: 207-577-1065
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT418
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: