Provider Demographics
NPI:1689204463
Name:DALEY, SHAYNE A (DC)
Entity Type:Individual
Prefix:DR
First Name:SHAYNE
Middle Name:A
Last Name:DALEY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 SOUTH DR
Mailing Address - Street 2:
Mailing Address - City:LACKAWANNA
Mailing Address - State:NY
Mailing Address - Zip Code:14218-3638
Mailing Address - Country:US
Mailing Address - Phone:716-548-5196
Mailing Address - Fax:
Practice Address - Street 1:1900 RIDGE RD STE 100
Practice Address - Street 2:
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224-3336
Practice Address - Country:US
Practice Address - Phone:716-677-2969
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-22
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013340-01111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor