Provider Demographics
NPI:1649581927
Name:EMBRACK-DALLEY, CYRA
Entity Type:Individual
Prefix:
First Name:CYRA
Middle Name:
Last Name:EMBRACK-DALLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 MELODY LN
Mailing Address - Street 2:
Mailing Address - City:AMITYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11701-1618
Mailing Address - Country:US
Mailing Address - Phone:718-251-5578
Mailing Address - Fax:
Practice Address - Street 1:6 MELODY LN
Practice Address - Street 2:
Practice Address - City:AMITYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11701-1618
Practice Address - Country:US
Practice Address - Phone:718-251-5578
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-01
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5262011163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool