Provider Demographics
NPI:1285723601
Name:WIELAND, DARYL (MD)
Entity type:Individual
Prefix:DR
First Name:DARYL
Middle Name:
Last Name:WIELAND
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 PEPPERCORN PL
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:NY
Mailing Address - Zip Code:10506-2209
Mailing Address - Country:US
Mailing Address - Phone:718-918-3060
Mailing Address - Fax:718-918-4469
Practice Address - Street 1:1400 PELHAM PARKWAY S
Practice Address - Street 2:BOLD 1 3 WEST6A
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461
Practice Address - Country:US
Practice Address - Phone:718-918-5443
Practice Address - Fax:718-918-6787
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY201511207VG0400X, 2083C0008X
NY201511-1207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No2083C0008XAllopathic & Osteopathic PhysiciansPreventive MedicineClinical Informatics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01961999Medicaid
CT49044OtherCT STATE LICENSE