Healthcare Provider Details

I. General information

NPI: 1134555352
Provider Name (Legal Business Name): REBECCA S BOYD RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2013
Last Update Date: 09/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4701 OGLETOWN STANTON RD HELEN F. GRAHAM CANCER CENTER, SUITE 2200
NEWARK DE
19713-2055
US

IV. Provider business mailing address

200 HYGEIA DR SUITE 2300
NEWARK DE
19713-2049
US

V. Phone/Fax

Practice location:
  • Phone: 302-623-4500
  • Fax: 302-623-7420
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDN-0000299
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: