Healthcare Provider Details

I. General information

NPI: 1184565095
Provider Name (Legal Business Name): DESIREE ALINE SURGUY FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2026
Last Update Date: 04/03/2026
Certification Date: 04/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 W GREEN ST
MIDDLETOWN DE
19709-1333
US

IV. Provider business mailing address

609 MAIN ST
CLAYTON DE
19938-8901
US

V. Phone/Fax

Practice location:
  • Phone: 302-223-4237
  • Fax:
Mailing address:
  • Phone: 302-223-4237
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberLG-0012880
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: