Healthcare Provider Details

I. General information

NPI: 1477423028
Provider Name (Legal Business Name): COASTAL NEUROLOGY AND WELLNESS CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2025
Last Update Date: 12/31/2025
Certification Date: 12/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33664 BAYVIEW MEDICAL DR UNIT 2
LEWES DE
19958-1933
US

IV. Provider business mailing address

33664 BAYVIEW MEDICAL DR UNIT 2
LEWES DE
19958-1933
US

V. Phone/Fax

Practice location:
  • Phone: 978-893-8900
  • Fax: 302-219-6066
Mailing address:
  • Phone: 978-893-8900
  • Fax: 978-893-8900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ANASTASIIA S ISRAEL
Title or Position: NURSE PRACTITIONER
Credential: APRN, AGACNP
Phone: 978-893-8900