Healthcare Provider Details

I. General information

NPI: 1255889572
Provider Name (Legal Business Name): SOMATUS NEPHROLOGY OF DELAWARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2016
Last Update Date: 09/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 STANTON CHRISTIANA RD SUITE 101
NEWARK DE
19713-2133
US

IV. Provider business mailing address

1650 TYSONS BLVD SUITE 900
MC LEAN VA
22102-4856
US

V. Phone/Fax

Practice location:
  • Phone: 877-495-7662
  • Fax:
Mailing address:
  • Phone: 877-495-7662
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VIII. Authorized Official

Name: SHAWANA LYNN DAVIS
Title or Position: OPERATIONS CONSULTANT
Credential:
Phone: 240-299-6991