Provider Demographics
NPI:1356408819
Name:MORIARTY DALEY, ALISON (PHD, APRN, PPCNP-BC)
Entity type:Individual
Prefix:
First Name:ALISON
Middle Name:
Last Name:MORIARTY DALEY
Suffix:
Gender:F
Credentials:PHD, APRN, PPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 27399
Mailing Address - Street 2:
Mailing Address - City:WEST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06516-0972
Mailing Address - Country:US
Mailing Address - Phone:203-737-2560
Mailing Address - Fax:203-785-6455
Practice Address - Street 1:20 YORK ST
Practice Address - Street 2:PEDIATRIC PRIMARY CARE ADOLESCENT CLINIC
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-3220
Practice Address - Country:US
Practice Address - Phone:203-688-9335
Practice Address - Fax:203-688-4516
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001137363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004185121Medicaid