Healthcare Provider Details

I. General information

NPI: 1851376354
Provider Name (Legal Business Name): MANISHA WADHWA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/07/2005
Last Update Date: 12/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5189 W WOODMILL DR
WILMINGTON DE
19808-4009
US

IV. Provider business mailing address

5189 W WOODMILL DR
WILMINGTON DE
19808-4009
US

V. Phone/Fax

Practice location:
  • Phone: 302-633-6001
  • Fax: 302-295-6289
Mailing address:
  • Phone: 302-633-6001
  • Fax: 302-295-6289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberC1-0007693
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberC1-0007693
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: