Healthcare Provider Details

I. General information

NPI: 1720365158
Provider Name (Legal Business Name): EVANS R KAMWANI PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2011
Last Update Date: 06/28/2023
Certification Date: 06/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 AVA DR
NEW CASTLE DE
19720-8866
US

IV. Provider business mailing address

321 AVA DR
NEW CASTLE DE
19720-8866
US

V. Phone/Fax

Practice location:
  • Phone: 302-276-4041
  • Fax:
Mailing address:
  • Phone: 302-276-4041
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License NumberL8-0010440
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberL8-0010440
License Number StateDE
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberL8-0010440
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: