Provider Demographics
NPI:1548693971
Name:DALY, TARA M (IBCLC)
Entity type:Individual
Prefix:MRS
First Name:TARA
Middle Name:M
Last Name:DALY
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 OSCEOLA RD
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-5001
Mailing Address - Country:US
Mailing Address - Phone:973-835-6872
Mailing Address - Fax:
Practice Address - Street 1:53 OSCEOLA RD
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-5001
Practice Address - Country:US
Practice Address - Phone:973-835-6872
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-21
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN