Provider Demographics
NPI:1174624860
Name:STORY, DARYL (MD)
Entity type:Individual
Prefix:
First Name:DARYL
Middle Name:
Last Name:STORY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:761 MAIN AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06851-1080
Mailing Address - Country:US
Mailing Address - Phone:203-853-5000
Mailing Address - Fax:203-853-5001
Practice Address - Street 1:761 MAIN AVE STE 201
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851-1080
Practice Address - Country:US
Practice Address - Phone:203-853-5000
Practice Address - Fax:203-853-5001
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2773782084N0400X
CT0394152084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001394155Medicaid
H47549Medicare UPIN
CT130000568Medicare ID - Type Unspecified