Healthcare Provider Details

I. General information

NPI: 1568107811
Provider Name (Legal Business Name): BROAD HEALTH, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2022
Last Update Date: 03/14/2023
Certification Date: 03/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16192 COASTAL HWY
LEWES DE
19958-3608
US

IV. Provider business mailing address

154 W 16TH ST # 6-110
NEW YORK NY
10011-6201
US

V. Phone/Fax

Practice location:
  • Phone: 402-650-3424
  • Fax:
Mailing address:
  • Phone: 617-513-4838
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JAMES STAHELI
Title or Position: OWNER
Credential: DO
Phone: 402-650-3424