Provider Demographics
NPI:1588236061
Name:DALY, NATHAN R (PHD)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:R
Last Name:DALY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 WEST ST UNIT 2410
Mailing Address - Street 2:
Mailing Address - City:BRAINTREE
Mailing Address - State:MA
Mailing Address - Zip Code:02184-3868
Mailing Address - Country:US
Mailing Address - Phone:763-283-8785
Mailing Address - Fax:
Practice Address - Street 1:800 WEST ST UNIT 2410
Practice Address - Street 2:
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184-3868
Practice Address - Country:US
Practice Address - Phone:763-283-8785
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-14
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program