Healthcare Provider Details

I. General information

NPI: 1215346150
Provider Name (Legal Business Name): ANESHA VICTOR NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2014
Last Update Date: 03/31/2025
Certification Date: 03/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94A OMEGA DR
NEWARK DE
19713-2066
US

IV. Provider business mailing address

PO BOX 67526
NEWARK NJ
07101-8009
US

V. Phone/Fax

Practice location:
  • Phone: 302-550-3484
  • Fax: 302-556-3484
Mailing address:
  • Phone: 302-266-9166
  • Fax: 866-670-8036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberLP-0000112
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberLP-0000112
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: