Healthcare Provider Details

I. General information

NPI: 1407395759
Provider Name (Legal Business Name): SEDELLE HENDERSON-BAMIDELE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2017
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1102 QUINTILIO DR
BEAR DE
19701-6004
US

IV. Provider business mailing address

PO BOX 10601
WILMINGTON DE
19850-0601
US

V. Phone/Fax

Practice location:
  • Phone: 302-481-4181
  • Fax:
Mailing address:
  • Phone: 302-276-9590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberSP-017144
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberLP-0000189
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: