Healthcare Provider Details

I. General information

NPI: 1083536247
Provider Name (Legal Business Name): AHMAD MALIK TAYLOR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1621 TELEGRAPH RD
WILMINGTON DE
19804-4113
US

IV. Provider business mailing address

1 BERWICK LN
BEAR DE
19701-4767
US

V. Phone/Fax

Practice location:
  • Phone: 302-434-6087
  • Fax:
Mailing address:
  • Phone: 302-757-6884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberU1-0012883
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: