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NPI Code Detail

MEDICARE: TEDDY JAMES DALEY

MEDICARE: TEDDY JAMES DALEY
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
1175T00000XPeer Specialist

General Provider Information

NPI Number : 1568188555
Entity Type Code : Individual
Provider Name (Legal Business Name) : TEDDY JAMES DALEY
Provider Business Mailing Address
First Line : 3311 12TH ST NW
Second Line :
City : CANTON
State : OH
Zip : 44708-3909
Country : US
Telephone Number : 330-459-2450
Fax Number :
Provider Business Practice Location Address
First Line : 3311 12TH ST NW
Second Line :
City : CANTON
State : OH
Zip : 44708-3909
Country : US
Telephone Number : 330-459-2450
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/12/2022
Last Update Date : 10/12/2022

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Directions to “ TEDDY JAMES DALEY ” Practice Location

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