Healthcare Provider Details

I. General information

NPI: 1407463524
Provider Name (Legal Business Name): ELIZABETH B SHORE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2020
Last Update Date: 10/26/2023
Certification Date: 10/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 S BRADFORD ST STE 9
DOVER DE
19904-4153
US

IV. Provider business mailing address

PO BOX 253
SKILLMAN NJ
08558-0253
US

V. Phone/Fax

Practice location:
  • Phone: 302-526-1959
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-23-68482
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: