Provider Demographics
NPI:1073577664
Name:DAILEY, VALERIE A (PA)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:A
Last Name:DAILEY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26908 DETROIT RD STE 103
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-2399
Mailing Address - Country:US
Mailing Address - Phone:440-249-0274
Mailing Address - Fax:440-808-1718
Practice Address - Street 1:26908 DETROIT RD STE 103
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-2399
Practice Address - Country:US
Practice Address - Phone:440-249-0274
Practice Address - Fax:440-808-1718
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50001997363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHDAPA79711Medicare ID - Type Unspecified
OHQ72639Medicare UPIN