Healthcare Provider Details

I. General information

NPI: 1992571335
Provider Name (Legal Business Name): FANTA H CABAH PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2023
Last Update Date: 05/12/2025
Certification Date: 05/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 NAAMANS RD STE 110
CLAYMONT DE
19703-2301
US

IV. Provider business mailing address

650 NAAMANS RD STE 110
CLAYMONT DE
19703-2301
US

V. Phone/Fax

Practice location:
  • Phone: 302-224-1400
  • Fax:
Mailing address:
  • Phone: 302-224-1400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberL1-0033104
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberL8-0010535
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: