Provider Demographics
NPI:1245211721
Name:DALY, MIRI (DNP)
Entity Type:Individual
Prefix:
First Name:MIRI
Middle Name:
Last Name:DALY
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 HAZARD AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:ENFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06082-5412
Mailing Address - Country:US
Mailing Address - Phone:860-272-2930
Mailing Address - Fax:860-272-2937
Practice Address - Street 1:141 HAZARD AVE
Practice Address - Street 2:SUITE B
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082-5443
Practice Address - Country:US
Practice Address - Phone:860-272-2930
Practice Address - Fax:860-272-2937
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT03-668583363LA2200X, 363LW0102X
CT521363L00000X
CT000521363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004204567Medicaid
S75525Medicare UPIN
CT500001528Medicare PIN