Provider Demographics
NPI:1376106443
Name:DALEY, ANDRE M (PA)
Entity Type:Individual
Prefix:
First Name:ANDRE
Middle Name:M
Last Name:DALEY
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:833 CHESTNUT ST STE 520
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-4430
Mailing Address - Country:US
Mailing Address - Phone:609-677-7003
Mailing Address - Fax:267-339-3761
Practice Address - Street 1:7975 LAKE UNDERHILL RD STE 330
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-8210
Practice Address - Country:US
Practice Address - Phone:844-407-4070
Practice Address - Fax:407-743-3050
Is Sole Proprietor?:No
Enumeration Date:2019-04-15
Last Update Date:2022-04-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9112006363A00000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL103007100Medicaid