MEDICARE: MS. WENDY CHERYL DAISLEY FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	33331365	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	33331365	OTHER		NY STATE

General Provider Information

NPI Number	:	1114169844
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. WENDY CHERYL DAISLEY FNP

Provider Business Mailing Address
First Line	:	440 W 114TH ST
Second Line	:	CLARKE 2 AREA H
City	:	NEW YORK
State	:	NY
Zip	:	10025-1796
Country	:	US
Telephone Number	:	212-523-3356
Fax Number	:	212-523-4553

Provider Business Practice Location Address
First Line	:	440 W 114TH ST
Second Line	:	CLARKE 2 AREA H
City	:	NEW YORK
State	:	NY
Zip	:	10025-1796
Country	:	US
Telephone Number	:	212-523-3356
Fax Number	:	212-523-4553

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/26/2009
Last Update Date	:	03/26/2009

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