Individual
DALERY GRULLON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
540 N DUKE ST, LANCASTER, PA 17602-2374
(717) 544-6111
Mailing address
2450 W HUNTING PARK AVE, PHILADELPHIA, PA 19129-1302
(215) 707-5030
(215) 707-3494
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
014920
NY
363A00000X
Physician Assistant
Primary
MA058779
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
014920
LICENSE
NY
Enumeration date
08/15/2011
Last updated
03/14/2024
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