Healthcare Provider Details

I. General information

NPI: 1558660175
Provider Name (Legal Business Name): KRISTIN L DALEY PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2011
Last Update Date: 08/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 MOCKINGBIRD LN STE 580
CHARLOTTE NC
28209
US

IV. Provider business mailing address

1515 MOCKINGBIRD LN STE 580
CHARLOTTE NC
28209-1171
US

V. Phone/Fax

Practice location:
  • Phone: 704-910-8381
  • Fax: 704-981-8282
Mailing address:
  • Phone: 704-910-8381
  • Fax: 704-981-8282

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173F00000X
TaxonomySleep Specialist (PhD)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number4239
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: