MEDICARE: DR. JEFFREY MEAD DALIA PSY.D.

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	103TF0200X	Forensic Psychologist	PY6473	FL

General Provider Information

NPI Number	:	1891918520
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY MEAD DALIA PSY.D.

Provider Business Mailing Address
First Line	:	136 LOST BRIDGE DR
Second Line	:
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33410-4471
Country	:	US
Telephone Number	:	561-308-4300
Fax Number	:

Provider Business Practice Location Address
First Line	:	205 N DIXIE HWY STE 4.1100
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33401-4522
Country	:	US
Telephone Number	:	561-355-4005
Fax Number	:	561-355-4004

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

Provider Enumeration Date	:	04/11/2007
Last Update Date	:	07/28/2014

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