Healthcare Provider Details

I. General information

NPI: 1730540808
Provider Name (Legal Business Name): ALISHA M BANAS AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DR. ALISHA M LATHAM

II. Dates (important events)

Enumeration Date: 03/16/2016
Last Update Date: 09/19/2022
Certification Date: 09/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

826 S GOVERNORS AVE
DOVER DE
19904
US

IV. Provider business mailing address

640 S. STATE STREET MAIL CODE 3055
DOVER DE
19901-3530
US

V. Phone/Fax

Practice location:
  • Phone: 302-674-3752
  • Fax: 302-674-8521
Mailing address:
  • Phone: 302-480-1688
  • Fax: 302-480-9807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number02-0000216
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: