Healthcare Provider Details

I. General information

NPI: 1609208487
Provider Name (Legal Business Name): AMY RELICH CUDDY PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2013
Last Update Date: 08/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 SHALLCROSS AVE SUITE 2
WILMINGTON DE
19806-3037
US

IV. Provider business mailing address

108 DELVIEW DR
WILMINGTON DE
19810-4408
US

V. Phone/Fax

Practice location:
  • Phone: 302-521-4670
  • Fax:
Mailing address:
  • Phone: 302-521-4670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberB1-0000721
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: