Individual
ODETTE C DALEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1350 HICKORY ST, MELBOURNE, FL 32901-3224
(407) 975-0406
(407) 975-0407
Mailing address
1350 HICKORY ST, MELBOURNE, FL 32901-3224
(407) 975-0406
(407) 975-0407
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
ME90087
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
230974
WELLCARE
FL
05
—
269744100
—
FL
01
—
3482134
AETNA
FL
01
—
43135
BLUE CROSS BLUE SHIELD
FL
01
—
7405509
AETNA
FL
01
—
9759635001
CIGNA
FL
01
—
P00138051
RAILROAD MEDICARE
FL
Enumeration date
11/09/2005
Last updated
11/06/2019
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