Provider Demographics
NPI:1962390971
Name:DALY, GRACE (MS, RD)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:DALY
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6142 N COUNTRY RD
Mailing Address - Street 2:
Mailing Address - City:WADING RIVER
Mailing Address - State:NY
Mailing Address - Zip Code:11792-1624
Mailing Address - Country:US
Mailing Address - Phone:631-599-3413
Mailing Address - Fax:
Practice Address - Street 1:6142 N COUNTRY RD
Practice Address - Street 2:
Practice Address - City:WADING RIVER
Practice Address - State:NY
Practice Address - Zip Code:11792-1624
Practice Address - Country:US
Practice Address - Phone:631-599-3413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-26
Last Update Date:2025-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered