Healthcare Provider Details

I. General information

NPI: 1285208694
Provider Name (Legal Business Name): STEPH DEPUTY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2021
Last Update Date: 05/19/2021
Certification Date: 05/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 W 10TH ST STE 1100
WILMINGTON DE
19801-6607
US

IV. Provider business mailing address

100 W 10TH ST STE 1100
WILMINGTON DE
19801-6607
US

V. Phone/Fax

Practice location:
  • Phone: 302-572-9622
  • Fax:
Mailing address:
  • Phone: 302-572-9622
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: