Healthcare Provider Details

I. General information

NPI: 1982241113
Provider Name (Legal Business Name): GEETA SHELLY PRASAD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2019
Last Update Date: 12/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 RAVENGLASS DRIVE
TOWNSEND DE
19734-1973
US

IV. Provider business mailing address

5700 KIRKWOOD HWY STE 204
WILMINGTON DE
19808-4884
US

V. Phone/Fax

Practice location:
  • Phone: 347-257-4407
  • Fax:
Mailing address:
  • Phone: 302-709-1303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: