Healthcare Provider Details

I. General information

NPI: 1457788036
Provider Name (Legal Business Name): PATRICK SALLAY MASSAQUOI N.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2013
Last Update Date: 09/11/2024
Certification Date: 09/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 SLEEPY HOLLOW DR
MIDDLETOWN DE
19709-5838
US

IV. Provider business mailing address

124 SLEEPY HOLLOW DR
MIDDLETOWN DE
19709-5838
US

V. Phone/Fax

Practice location:
  • Phone: 302-623-0188
  • Fax: 302-322-6251
Mailing address:
  • Phone: 302-652-2455
  • Fax: 302-322-6251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberLG-0000692
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberLG-0000692
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: