Healthcare Provider Details

I. General information

NPI: 1689959538
Provider Name (Legal Business Name): BEACON PEDIATRICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2011
Last Update Date: 05/09/2025
Certification Date: 05/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18947 JOHN J WILLIAMS HWY SUITE 212
REHOBOTH BEACH DE
19971-4474
US

IV. Provider business mailing address

18947 JOHN J WILLIAMS HWY SUITE 212
REHOBOTH BEACH DE
19971-4474
US

V. Phone/Fax

Practice location:
  • Phone: 302-645-8212
  • Fax: 302-645-2199
Mailing address:
  • Phone: 302-645-8212
  • Fax: 302-645-2199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. NANCY M GIDEON
Title or Position: MD/PRACTICE OWNER
Credential: MD
Phone: 302-645-8212