Healthcare Provider Details

I. General information

NPI: 1326970245
Provider Name (Legal Business Name): PLATINUM PROSTHESES PROFESSIONAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 ZELKOVA RD
SMYRNA DE
19977-3967
US

IV. Provider business mailing address

12 ZELKOVA RD
SMYRNA DE
19977-3967
US

V. Phone/Fax

Practice location:
  • Phone: 215-733-9960
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: MRS. SAUDA SIMPSON
Title or Position: OWNWER
Credential:
Phone: 215-733-9960