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General NPI Number Information
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NPI Number | 1013189877
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Entity Type | Individual
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Provider Name | TYLER JAY STALEY M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/01/2008
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Last Update Date | 07/11/2013
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Provider Practice Location Address
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Address Line | 350 N CLYDE MORRIS BLVD
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City | DAYTONA BEACH
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State | FL
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Zip | 32114-2733
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Country | US
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Telephone | 386-238-3290
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Fax | 386-238-3278
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Provider Business Mailing Address
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Address Line | PO BOX 9671
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City | DAYTONA BEACH
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State | FL
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Zip | 32120-9671
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Country | US
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Telephone | 386-676-7130
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Fax | 386-676-7125
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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 | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 44335
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 2081S0010X
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Taxonomy Name | Sports Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | 112139
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License Number State | FL
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