Healthcare Provider Details

I. General information

NPI: 1487222477
Provider Name (Legal Business Name): DEEPA GANESAN MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2021
Last Update Date: 02/12/2024
Certification Date: 03/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2724 E RIDING DR
WILMINGTON DE
19808-3643
US

IV. Provider business mailing address

2724 E RIDING DR
WILMINGTON DE
19808-3643
US

V. Phone/Fax

Practice location:
  • Phone: 646-889-3980
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number75385327
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: