Healthcare Provider Details

I. General information

NPI: 1770080764
Provider Name (Legal Business Name): MIRI SHLOMI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2018
Last Update Date: 01/22/2025
Certification Date: 01/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32060 LONG NECK RD
MILLSBORO DE
19966-6228
US

IV. Provider business mailing address

2780 CLEVELAND AVE STE 709
FORT MYERS FL
33901-5857
US

V. Phone/Fax

Practice location:
  • Phone: 302-645-3150
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC1-0025993
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: