=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457042889
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ZHI TING SHERRY DALEY APRN, FNP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/17/2023
-----------------------------------------------------
Last Update Date | 05/17/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 64 ROBBINS ST
-----------------------------------------------------
City | WATERBURY
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06708-2613
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-573-6000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 133 POND MEADOW RD
-----------------------------------------------------
City | KILLINGWORTH
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06419-1136
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 11840
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------