Healthcare Provider Details

I. General information

NPI: 1528508009
Provider Name (Legal Business Name): YOSEPH FISAHAYE TEWELDEBRHAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2017
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

804 N DUPONT BLVD
MILFORD DE
19963-1006
US

IV. Provider business mailing address

640 S STATE ST MAILCODE: 3007
DOVER DE
19901-3530
US

V. Phone/Fax

Practice location:
  • Phone: 302-725-3557
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberR198411
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR198411
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberC7-0019209
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: