Healthcare Provider Details

I. General information

NPI: 1154174662
Provider Name (Legal Business Name): ASHLEY DYCK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2024
Last Update Date: 06/18/2024
Certification Date: 06/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 ROCKLAND RD STE 3D16
WILMINGTON DE
19803-3607
US

IV. Provider business mailing address

1600 ROCKLAND RD STE 3D16
WILMINGTON DE
19803-3607
US

V. Phone/Fax

Practice location:
  • Phone: 302-651-5874
  • Fax: 302-651-5954
Mailing address:
  • Phone: 302-651-5874
  • Fax: 302-651-5954

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC7-0018507
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: