Healthcare Provider Details

I. General information

NPI: 1396654844
Provider Name (Legal Business Name): MS. VANESSA JEANNE BRUSSEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 S COLLEGE AVE
NEWARK DE
19713
US

IV. Provider business mailing address

605 S COLLEGE AVE
NEWARK DE
19713
US

V. Phone/Fax

Practice location:
  • Phone: 302-831-2226
  • Fax:
Mailing address:
  • Phone: 302-831-2226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: