=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245320225
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BROWNSBORO PARK PEDIATRICS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/13/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6002 BROWNSBORO PARK BLVD
-----------------------------------------------------
City | LOUISVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40207-1298
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 502-897-3232
-----------------------------------------------------
Fax | 502-895-4389
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6002 BROWNSBORO PARK BLVD
-----------------------------------------------------
City | LOUISVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40207-1298
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 502-897-3232
-----------------------------------------------------
Fax | 502-895-4389
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DOCTOR
-----------------------------------------------------
Name | MS. WENDY C DALY
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 502-895-4389
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------