Healthcare Provider Details

I. General information

NPI: 1083452122
Provider Name (Legal Business Name): AFUA OWUSU-DONKOR PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2024
Last Update Date: 07/15/2024
Certification Date: 07/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

644 S QUEEN ST STE 106
DOVER DE
19904-3543
US

IV. Provider business mailing address

112 BLUE BEACH RD
DOVER DE
19904-4824
US

V. Phone/Fax

Practice location:
  • Phone: 302-678-9002
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0012086
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: