TYLER JAY STALEY (NPI# 1013189877) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1013189877 |
| Entity Type | Individual |
| Full Name | TYLER JAY STALEY |
| Credential | M.D. |
| Practice Address |
350 N Clyde Morris Blvd Daytona Beach FL 32114-2733 |
| Mailing Address |
Po Box 9671 Daytona Beach FL 32120-9671 |
| Practice Telephone | 3862383290 |
| Practice Fax Number | 3862383278 |
| Mailing Telephone | 3866767130 |
| Mailing Fax Number | 3866767125 |
| Enumeration Date | 2008-04-01 |
| Last Update Date | 2013-07-11 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 208100000X | Physical Medicine & Rehabilitation | 44335 | KY | Allopathic & Osteopathic Physicians |
| Y | 2081S0010X |
Physical Medicine & Rehabilitation Specialization: Sports Medicine |
112139 | FL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | 007276600 | 05 | |
| FL | TRICARE | 1013189877 | 01 |
| FL | BCBS | 14MV1 | 01 |
| Street Address |
350 N CLYDE MORRIS BLVD |
| City | DAYTONA BEACH |
| State | FL |
| Zip Code | 32114-2733 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063405975 | Mary June Derbenwick | Psychiatry & Neurology | 350 N Clyde Morris Blvd, Daytona Beach, FL 32114-2733 | 2005-08-25 |
| 1205451705 | Tiffany Varela Khan | Nurse Practitioner | 350 N Clyde Morris Blvd, Daytona Beach, FL 32114-2733 | 2020-06-10 |
| 1245696301 | Andrea Likens | Dietitian, Registered | 350 N Clyde Morris Blvd, Suite 9, Daytona Beach, FL 32114-2733 | 2016-01-05 |
| 1245560291 | Cara J Karner | Dietetic Technician, Registered | 350 N Clyde Morris Blvd, Daytona Beach, FL 32114-2733 | 2010-01-13 |
| 1083734784 | Mark A Miller | Pharmacist | 350 N Clyde Morris Blvd, Daytona Beach, FL 32114-2733 | 2007-03-29 |
| 1841322005 | Florida Health Care Plans Inc | Pharmacy | 350 N Clyde Morris Blvd, Daytona Beach, FL 32114-2733 | 2007-03-12 |
| 1730258088 | Richard Frank Miller | Nurse Practitioner | 350 N Clyde Morris Blvd, Daytona Beach, FL 32114-2733 | 2006-11-08 |
| 1154408904 | Joseph Michael Zobian | Ophthalmology | 350 N Clyde Morris Blvd, Daytona Beach, FL 32114-2733 | 2006-11-01 |
| 1518070119 | Niloufar Tabatabaei Wilson | Internal Medicine | 350 N Clyde Morris Blvd, Daytona Beach, FL 32114-2795 | 2006-08-16 |
| 1851309629 | Stephen E Minor | Internal Medicine | 350 N Clyde Morris Blvd, Suite 1, Daytona Beach, FL 32114-2733 | 2006-08-04 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376161380 | Evolution Health & Performance LLC | Physician Assistant | 244 S. Palmetto Ave, Daytona Beach, FL 32114 | 2020-07-07 |
| 1407480189 | Kierra Imani Kinsey | Behavior Technician | 1128-a Beville Rd, Daytona Beach, FL 32114 | 2020-03-02 |
| 1043776057 | Outreach Community Care Network Inc | Pharmacy | 240 N. Frederick Avenue, Daytona Beach, FL 32114 | 2019-02-14 |
| 1033681861 | Katherine Proppe | Specialist/Technologist | 1 Aerospace Blvd, Daytona Beach, FL 32114 | 2018-12-18 |
| 1841765047 | Anna L Smith | Nurse Practitioner | 339 Bill France Blvd Ste C, Daytona Beach, FL 32114 | 2018-10-04 |
| 1154806933 | Steve Anthony Lee | Family Medicine | 731 N. Clyde Morris Blvd, Daytona Beach, FL 32114 | 2018-09-27 |
| 1285116491 | Walgreen Co | Durable Medical Equipment & Medical Supplies | 1348 W International Speedway Blvd Ste 2, Daytona Beach, FL 32114 | 2018-09-04 |
| 1770085656 | Merina Lee | Occupational Therapist | 1159 Australia Ave., Daytona Beach, FL 32114 | 2018-03-06 |
| 1346752755 | Hand & Upper Extremity Surgery of Daytona Beach, LLC | Non-Pharmacy Dispensing Site | 1241 Ridgewood Ave, Daytona Beach, FL 32114 | 2017-10-26 |
| 1104347053 | Harry Herman Blanke IIi | Family Medicine | 201 N Clyde Morris Blvd, Suite 200, Halifax Health Family Medicine Residency Program, Daytona Beach, FL 32114 | 2017-06-30 |
| Find all providers in zip 32114 | ||||
| Taxonomy Code | 2081S0010X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Physical Medicine & Rehabilitation |
| Specialization | Sports Medicine |
| A physician who specializes in Sports Medicine is responsible for continuous care related to the enhancement of health and fitness as well as the prevention of injury and illness. The specialist possesses knowledge and experience in the promotion of wellness and the prevention of injury from many areas of medicine such as exercise physiology, biomechanics, nutrition, psychology, physical rehabilitation, epidemiology, physical evaluation and injuries. It is the goal of a Sports Medicine specialist to improve the healthcare of the individual engaged in physical exercise. |
| Notes: Source: American Board of Medical Specialties, 2009. www.abms.org [7/1/2009: definition added] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295372027 | Wholehealth Physical Therapy, LLC | Physical Medicine & Rehabilitation | 21123 Via Ventura, Boca Raton, FL 33433-2230 | 2019-11-27 |
| 1306404843 | Gregory Carvajal | Physical Medicine & Rehabilitation | 3425 Nw 180th St, Miami Gardens, FL 33056-3429 | 2019-05-30 |
| 1871059196 | Michaela Moran | Physical Medicine & Rehabilitation | 2750 John Prom Blvd, Jacksonville, FL 32246-3921 | 2019-02-11 |
| 1194298216 | Courtney Quinn | Physical Medicine & Rehabilitation | 6233 Royal Tern St, Orlando, FL 32810-6085 | 2019-01-11 |
| 1063997260 | Kneaded Therapy, Inc | Physical Medicine & Rehabilitation | 2746 E Commerical Blvd., Ft. Lauderdale, FL 33308 | 2018-10-03 |
| 1376023481 | Michelle L Stinehelfer | Physical Medicine & Rehabilitation | 1418 East Bloomingdale Avenue, Valrico, FL 33596 | 2018-08-17 |
| 1942715255 | Michael Clark | Physical Medicine & Rehabilitation | 10600 Riverside Drive, Coral Springs, FL 33071-3307 | 2017-12-08 |
| 1003266537 | Christiana Marron | Physical Medicine & Rehabilitation | 800 E Broward Blvd Ste 102, Fort Lauderdale, FL 33301-2020 | 2016-06-15 |
| 1780046177 | Shawn Darmond Homans | Physical Medicine & Rehabilitation | 13539 N Florida Ave, Tampa, FL 33613-3203 | 2016-03-24 |
| 1376933507 | Jessica Benshoshan | Physical Medicine & Rehabilitation | 6251 Palm Trace Landings Dr, Apt # 113, Davie, FL 33314-1841 | 2015-01-26 |
| Find all providers with the same taxonomy | ||||
| City | DAYTONA BEACH |
| Zip Code | 32114 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.