Provider Demographics
NPI:1346668613
Name:DALEY, NICHOLAS CODY (DO)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:CODY
Last Name:DALEY
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 1:6360 S 3000 E STE 200
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-6925
Mailing Address - Country:US
Mailing Address - Phone:801-797-8000
Mailing Address - Fax:855-769-3885
Practice Address - Street 1:6360 S 3000 E STE 200
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84121-6925
Practice Address - Country:US
Practice Address - Phone:801-797-8000
Practice Address - Fax:855-769-3885
Is Sole Proprietor?:No
Enumeration Date:2014-04-02
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1202995012042081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine