Healthcare Provider Details

I. General information

NPI: 1649016858
Provider Name (Legal Business Name): MENATOLLA A SOLIMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2024
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 KIRKWOOD HWY
WILMINGTON DE
19805-4917
US

IV. Provider business mailing address

110 TROY DR
SPRINGFIELD NJ
07081-2067
US

V. Phone/Fax

Practice location:
  • Phone: 302-994-2511
  • Fax:
Mailing address:
  • Phone: 908-247-4675
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number0618003628
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberI4-0010148
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: