Healthcare Provider Details

I. General information

NPI: 1679382832
Provider Name (Legal Business Name): SIMONE DENNIS DOULA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2025
Last Update Date: 01/02/2025
Certification Date: 01/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 CHESWOLD BLVD APT 3A
NEWARK DE
19713-4171
US

IV. Provider business mailing address

4 CHESWOLD BLVD APT 3A
NEWARK DE
19713-4171
US

V. Phone/Fax

Practice location:
  • Phone: 302-467-9593
  • Fax:
Mailing address:
  • Phone: 302-467-9593
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number1864488
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: