Healthcare Provider Details

I. General information

NPI: 1649920216
Provider Name (Legal Business Name): GIDEON ESUZOR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2022
Last Update Date: 09/13/2025
Certification Date: 09/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 PENNSYLVANIA AVE UNIT LLC
WILMINGTON DE
19806-1392
US

IV. Provider business mailing address

13603 WHITE BARN LN
HERNDON VA
20171-3341
US

V. Phone/Fax

Practice location:
  • Phone: 302-213-6158
  • Fax: 855-530-2764
Mailing address:
  • Phone: 404-788-2882
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRN190476
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0024189217
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAC006300
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberL8-0010781
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: