Healthcare Provider Details

I. General information

NPI: 1285498121
Provider Name (Legal Business Name): ETHELYN DALEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2024
Last Update Date: 02/12/2024
Certification Date: 02/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 TARRYTOWN RD
WHITE PLAINS NY
10607-1607
US

IV. Provider business mailing address

60 CORNELL AVE
YONKERS NY
10705-2413
US

V. Phone/Fax

Practice location:
  • Phone: 914-761-6566
  • Fax:
Mailing address:
  • Phone: 917-804-0691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberF421536-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: