Healthcare Provider Details

I. General information

NPI: 1740854512
Provider Name (Legal Business Name): SALLY DELORY NP IN FAMILY HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2021
Last Update Date: 08/30/2021
Certification Date: 08/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 EXECUTIVE PARK DRIVE, SUITE 1
ALBANY NY
12203-3700
US

IV. Provider business mailing address

2 EXECUTIVE PARK DRIVE, SUITE 1
ALBANY NY
12203-3700
US

V. Phone/Fax

Practice location:
  • Phone: 518-323-2828
  • Fax: 518-313-5860
Mailing address:
  • Phone: 518-323-2828
  • Fax: 518-313-5860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SALLY DELORY
Title or Position: NURSE PRACTITIONER
Credential:
Phone: 518-227-5339