Healthcare Provider Details

I. General information

NPI: 1174192827
Provider Name (Legal Business Name): DELAWARE PHYSIATRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2021
Last Update Date: 02/05/2025
Certification Date: 02/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 COLLEGE PARK DR STE 203
DOVER DE
19904-8727
US

IV. Provider business mailing address

1221 COLLEGE PARK DR STE 203
DOVER DE
19904-8727
US

V. Phone/Fax

Practice location:
  • Phone: 302-387-1407
  • Fax: 877-381-4173
Mailing address:
  • Phone: 302-387-1407
  • Fax: 877-381-4173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2081P0301X
TaxonomyBrain Injury Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: JESSICA SAMPATHKUMAR
Title or Position: OWNER
Credential:
Phone: 302-387-1407