Basic Information
| Provider Information | |||||||||
| NPI: | 1558301929 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DALY | ||||||||
| FirstName: | SEANA | ||||||||
| MiddleName: | K | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 63701 E SADDLEBROOKE BLVD STE F | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857391273 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2085713172 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 63701 E SADDLEBROOKE BLVD STE F | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857391273 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5208180300 | ||||||||
| FaxNumber: | 5208182508 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/07/2006 | ||||||||
| LastUpdateDate: | 01/27/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/27/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 49830 | AZ | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | M5347 | ID | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 003668800 | 05 | ID | MEDICAID |