Healthcare Provider Details

I. General information

NPI: 1851371447
Provider Name (Legal Business Name): NIDIA DEYANEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2006
Last Update Date: 04/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 PENNSYLVANIA AVE STE 110
WILMINGTON DE
19806-1401
US

IV. Provider business mailing address

2401 PENNSYLVANIA AVE STE 110
WILMINGTON DE
19806-1401
US

V. Phone/Fax

Practice location:
  • Phone: 302-655-2991
  • Fax: 302-655-1944
Mailing address:
  • Phone: 302-655-2991
  • Fax: 302-655-1944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberC10002059
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: