Provider Demographics
NPI:1184215691
Name:DALZELL, HALEY (PA-C)
Entity Type:Individual
Prefix:
First Name:HALEY
Middle Name:
Last Name:DALZELL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 PEABODY DR
Mailing Address - Street 2:
Mailing Address - City:STOW
Mailing Address - State:MA
Mailing Address - Zip Code:01775-1010
Mailing Address - Country:US
Mailing Address - Phone:978-793-0011
Mailing Address - Fax:
Practice Address - Street 1:4 MERCER RD
Practice Address - Street 2:
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760-2415
Practice Address - Country:US
Practice Address - Phone:508-318-4466
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-27
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant