Provider Demographics
NPI:1497114375
Name:FITZGERALD, DARYL
Entity Type:Individual
Prefix:
First Name:DARYL
Middle Name:
Last Name:FITZGERALD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:927 JENKINS CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:VA
Mailing Address - Zip Code:23040-2036
Mailing Address - Country:US
Mailing Address - Phone:804-491-6655
Mailing Address - Fax:
Practice Address - Street 1:927 JENKINS CHURCH RD
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:VA
Practice Address - Zip Code:23040-2036
Practice Address - Country:US
Practice Address - Phone:434-906-5922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-19
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 225600000X, 225C00000X, 373H00000X, 374U00000X, 376G00000X, 376J00000X, 376K00000X
VAT67507941172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No225600000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDance Therapist
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor
No373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist
No374U00000XNursing Service Related ProvidersHome Health Aide
No376G00000XNursing Service Related ProvidersNursing Home Administrator
No376J00000XNursing Service Related ProvidersHomemaker
No376K00000XNursing Service Related ProvidersNurse's Aide