Provider Demographics
NPI:1124196282
Name:DIANA L DALY PA
Entity Type:Organization
Organization Name:DIANA L DALY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:DALY
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC SLP
Authorized Official - Phone:813-767-2373
Mailing Address - Street 1:6211 TANAGER PLACE
Mailing Address - Street 2:DIANA L DALY PA SPEECH LANGUAGE PATHOLOGY
Mailing Address - City:TEMPLE TERRACE
Mailing Address - State:FL
Mailing Address - Zip Code:33617
Mailing Address - Country:US
Mailing Address - Phone:813-767-2373
Mailing Address - Fax:813-985-7026
Practice Address - Street 1:6211 TANAGER PLACE
Practice Address - Street 2:
Practice Address - City:TEMPLE TERRACE
Practice Address - State:FL
Practice Address - Zip Code:33617
Practice Address - Country:US
Practice Address - Phone:813-767-2373
Practice Address - Fax:813-985-7026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2014-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA6227235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL889412400Medicaid
289447OtherSTAYWELL WELLCARE