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General NPI Number Information
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NPI Number | 1295233997
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Entity Type | Individual
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Provider Name | JENNELLE LYNNE DALY PA-C
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Gender | Female
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Dates
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Enumeration Date | 01/28/2018
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Last Update Date | 11/09/2024
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Provider Practice Location Address
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Address Line | 9300 E RAINTREE DR STE 130
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City | SCOTTSDALE
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State | AZ
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Zip | 85260-7313
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Country | US
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Telephone | 602-677-4312
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Fax |
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Provider Business Mailing Address
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Address Line | 4842 E EMILE ZOLA AVE
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City | SCOTTSDALE
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State | AZ
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Zip | 85254-3518
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Country | US
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Telephone | 561-672-9209
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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 | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number | 7105
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 7105
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License Number State | AZ
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Taxonomy #3
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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Taxonomy #4
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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 | 7105
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License Number State | AZ
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