Healthcare Provider Details

I. General information

NPI: 1205798170
Provider Name (Legal Business Name): IRIS N AYALA CPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2025
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

406 W SUMMIT AVE
WILMINGTON DE
19804-1812
US

IV. Provider business mailing address

PO BOX 5112
WILMINGTON DE
19808-0112
US

V. Phone/Fax

Practice location:
  • Phone: 302-377-1803
  • Fax:
Mailing address:
  • Phone: 302-377-1803
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: