Provider Demographics
NPI:1114169844
Name:DAISLEY, WENDY CHERYL (FNP)
Entity Type:Individual
Prefix:MS
First Name:WENDY
Middle Name:CHERYL
Last Name:DAISLEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MS
Other - First Name:WENDY
Other - Middle Name:CHERYL
Other - Last Name:DAISLEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP
Mailing Address - Street 1:440 W 114TH ST
Mailing Address - Street 2:CLARKE 2 AREA H
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-1796
Mailing Address - Country:US
Mailing Address - Phone:212-523-3356
Mailing Address - Fax:212-523-4553
Practice Address - Street 1:440 W 114TH ST
Practice Address - Street 2:CLARKE 2 AREA H
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-1796
Practice Address - Country:US
Practice Address - Phone:212-523-3356
Practice Address - Fax:212-523-4553
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-26
Last Update Date:2009-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY33331365363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
33331365OtherNY STATE