Provider Demographics
NPI:1457749665
Name:DALY-GORDON, EDRIS INEZ (RD, EDD)
Entity Type:Individual
Prefix:
First Name:EDRIS
Middle Name:INEZ
Last Name:DALY-GORDON
Suffix:
Gender:F
Credentials:RD, EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:962 CHERRY BRANCH CT
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-1944
Mailing Address - Country:US
Mailing Address - Phone:407-591-9353
Mailing Address - Fax:407-804-9517
Practice Address - Street 1:962 CHERRY BRANCH CT
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-1944
Practice Address - Country:US
Practice Address - Phone:407-591-9353
Practice Address - Fax:407-804-9517
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-23
Last Update Date:2014-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9209010163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health