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General NPI Number Information
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NPI Number | 1003246679
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Entity Type | Individual
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Provider Name | STEPHANIE DALEY
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Gender | Female
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Dates
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Enumeration Date | 11/19/2013
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Last Update Date | 06/11/2019
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Provider Practice Location Address
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Address Line | 12845 BROADWAY ST STE 2
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City | ALDEN
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State | NY
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Zip | 14004-1223
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Country | US
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Telephone | 716-902-5068
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Fax |
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Provider Business Mailing Address
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Address Line | 12845 BROADWAY ST STE 2
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City | ALDEN
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State | NY
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Zip | 14004-1223
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Country | US
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Telephone | 171-690-2506
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 037140
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License Number State | NY
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