Healthcare Provider Details

I. General information

NPI: 1003732538
Provider Name (Legal Business Name): TELEDALASE OGUNDIPE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2513 CEDAR TREE DR APT 3D
WILMINGTON DE
19810-1432
US

IV. Provider business mailing address

2513 CEDAR TREE DR APT 3D
WILMINGTON DE
19810-1432
US

V. Phone/Fax

Practice location:
  • Phone: 302-242-2029
  • Fax:
Mailing address:
  • Phone: 302-242-2029
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberL1-0050500
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: