Healthcare Provider Details

I. General information

NPI: 1629709050
Provider Name (Legal Business Name): CHRISTINA MINISSALE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2022
Last Update Date: 09/04/2025
Certification Date: 09/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18068 COASTAL HWY
LEWES DE
19958-4901
US

IV. Provider business mailing address

502 LEE ANN RD
CHERRY HILL NJ
08034-1338
US

V. Phone/Fax

Practice location:
  • Phone: 302-567-1500
  • Fax:
Mailing address:
  • Phone: 215-622-7143
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PP0204X
TaxonomyPediatric Emergency Medicine (Emergency Medicine) Physician
License Number207PP0204X
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberLJ-0010514
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: