Healthcare Provider Details

I. General information

NPI: 1588518708
Provider Name (Legal Business Name): SHANICA MCINTOSH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2026
Last Update Date: 02/25/2026
Certification Date: 02/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 CHURCHMANS RD STE 101
NEWARK DE
19702-1945
US

IV. Provider business mailing address

523 VANDEVER AVE
WILMINGTON DE
19802-4240
US

V. Phone/Fax

Practice location:
  • Phone: 302-658-2229
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberLK-0010269
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: