Healthcare Provider Details

I. General information

NPI: 1649004102
Provider Name (Legal Business Name): SHARDAY TOLLIVER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2024
Last Update Date: 08/28/2024
Certification Date: 08/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

256 CHAPMAN RD
NEWARK DE
19702-5499
US

IV. Provider business mailing address

237 WEDGEFIELD CIR
NEW CASTLE DE
19720-3751
US

V. Phone/Fax

Practice location:
  • Phone: 302-292-1334
  • Fax:
Mailing address:
  • Phone: 267-423-8813
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: