Healthcare Provider Details

I. General information

NPI: 1679359160
Provider Name (Legal Business Name): DELAWARE SPORTS MEDICINE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2023
Last Update Date: 08/31/2023
Certification Date: 08/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3920 DUPONT PKWY STE B
TOWNSEND DE
19734-9000
US

IV. Provider business mailing address

3920 DUPONT PKWY STE A
TOWNSEND DE
19734-9000
US

V. Phone/Fax

Practice location:
  • Phone: 302-792-7222
  • Fax:
Mailing address:
  • Phone: 302-792-7222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. SYLVIA CANTEEN-BROWN
Title or Position: PRACTICE MANAGER
Credential:
Phone: 302-792-7222