Provider Demographics
NPI:1730975269
Name:HUNT, DALLAS RAE
Entity type:Individual
Prefix:
First Name:DALLAS
Middle Name:RAE
Last Name:HUNT
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1919 VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13207-2835
Mailing Address - Country:US
Mailing Address - Phone:315-575-2040
Mailing Address - Fax:
Practice Address - Street 1:1919 VALLEY DR
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13207-2835
Practice Address - Country:US
Practice Address - Phone:315-575-2040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-21
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY328673164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse