Provider Demographics
NPI:1225157902
Name:DALY, STEPHEN D (DO)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:D
Last Name:DALY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 PIIKEA AVE STE A
Mailing Address - Street 2:
Mailing Address - City:KIHEI
Mailing Address - State:HI
Mailing Address - Zip Code:96753-8268
Mailing Address - Country:US
Mailing Address - Phone:808-874-8100
Mailing Address - Fax:808-874-6887
Practice Address - Street 1:221 PIIKEA AVE STE A
Practice Address - Street 2:
Practice Address - City:KIHEI
Practice Address - State:HI
Practice Address - Zip Code:96753-8268
Practice Address - Country:US
Practice Address - Phone:808-874-8100
Practice Address - Fax:808-874-6887
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI51010144932083X0100X
HI941207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI1504Medicare PIN
MIMI1503022Medicare UPIN
MIMI1504022Medicare UPIN
MIMI1503Medicare PIN