Provider Demographics
NPI:1639282783
Name:DALY, RICHARD (FNP-C)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:DALY
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 LOCUST AVE
Mailing Address - Street 2:
Mailing Address - City:MILLER PLACE
Mailing Address - State:NY
Mailing Address - Zip Code:11764-2014
Mailing Address - Country:US
Mailing Address - Phone:631-681-8062
Mailing Address - Fax:631-681-8062
Practice Address - Street 1:75 N COUNTRY RD
Practice Address - Street 2:JOHN T MATHER MEMORIAL HOSPITAL
Practice Address - City:PORT JEFFERSON
Practice Address - State:NY
Practice Address - Zip Code:11777-2119
Practice Address - Country:US
Practice Address - Phone:631-473-1320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF334091363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ21819Medicare UPIN