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NPI Code Detail

MEDICARE: MRS. LAKISHA DELVALLE

MEDICARE: MRS. LAKISHA DELVALLE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LP0808XPsychiatric/Mental Health Nurse PractitionerINTERNNJ

General Provider Information

NPI Number : 1164213112
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. LAKISHA DELVALLE
Provider Business Mailing Address
First Line : 1417 BRACE RD STE C
Second Line :
City : CHERRY HILL
State : NJ
Zip : 08034-3524
Country : US
Telephone Number : 856-795-0036
Fax Number : 856-795-0039
Provider Business Practice Location Address
First Line : 1417 BRACE RD STE C
Second Line :
City : CHERRY HILL
State : NJ
Zip : 08034-3524
Country : US
Telephone Number : 856-333-3783
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/16/2025
Last Update Date : 01/23/2026

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Directions to “ MRS. LAKISHA DELVALLE ” Practice Location

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