Healthcare Provider Details

I. General information

NPI: 1629069182
Provider Name (Legal Business Name): PREACHESS VELLAH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2005
Last Update Date: 06/04/2025
Certification Date: 06/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

424 SAVANNAH RD
LEWES DE
19958-1462
US

IV. Provider business mailing address

1515 SAVANNAH RD
LEWES DE
19958-1675
US

V. Phone/Fax

Practice location:
  • Phone: 302-645-3525
  • Fax: 302-645-3513
Mailing address:
  • Phone: 302-645-3499
  • Fax: 302-644-4830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberC10007190
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberC10007190
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: