Provider Demographics
NPI:1932729027
Name:DALEY, MONIQUE MARIE (HEALTH COACH)
Entity Type:Individual
Prefix:
First Name:MONIQUE
Middle Name:MARIE
Last Name:DALEY
Suffix:
Gender:F
Credentials:HEALTH COACH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:278 BEDFORD PARK BLVD APT 5C
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10458-2547
Mailing Address - Country:US
Mailing Address - Phone:646-644-3001
Mailing Address - Fax:
Practice Address - Street 1:278 BEDFORD PARK BLVD APT 5C
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458-2547
Practice Address - Country:US
Practice Address - Phone:646-644-3001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-20
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVHCC5J2P7Q6405300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes405300000XOther Service ProvidersPrevention ProfessionalGroup - Single Specialty