Jennelle Lynne Daly, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

Practice address

9300 E Raintree Dr Ste 130
Scottsdale, AZ 85260-7313

Phone

(602) 677-4312

NPI assigned

Jan 28, 2018

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Mayne Medical, LLC

  • Physical Medicine & Rehabilitation Physician
  • Phoenix, AZ
  • NPI 1366170656
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1517097600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731110400000",
    "number": "1295233997",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4842 E EMILE ZOLA AVE",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852543518",
            "telephone_number": "561-672-9209"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9300 E RAINTREE DR STE 130",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852607313",
            "telephone_number": "602-677-4312"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DALY",
        "first_name": "JENNELLE",
        "middle_name": "LYNNE",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-01-28",
        "last_updated": "2024-11-09",
        "certification_date": "2024-11-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208VP0014X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "AZ",
            "license": "7105",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant, Medical",
            "state": "AZ",
            "license": "7105",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2081S0010X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation, Sports Medicine",
            "state": "AZ",
            "license": "7105",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Richard Dalotto, FP
• Roxanne Dalpos, PHD, LPC, NCC
• Andrew Ryan Dalrymple
• Kaylie Nicole Dalton, PA-C
• Christopher John Daly, MS, OTRL, MBA
• Kortney Daly, PA-C
• Karen J Dame, CHC
• Priscilla Damian, NP
• Amanda Dawn Damiris, PA-C
• Dan P Featherston MD PC

• Medical Physician Assistant in Scottsdale, AZ
• Providers in Scottsdale, AZ by specialty
• Medical Physician Assistant in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.