Healthcare Provider Details

I. General information

NPI: 1043146632
Provider Name (Legal Business Name): ELISA DALTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 BEDFORD ST APT 28
NEW YORK NY
10014-4463
US

IV. Provider business mailing address

17 CANTERBURY LN
SHORT HILLS NJ
07078-3301
US

V. Phone/Fax

Practice location:
  • Phone: 973-953-9231
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number033906
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: