Healthcare Provider Details

I. General information

NPI: 1912795774
Provider Name (Legal Business Name): SHANIKKA HARMON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2025
Last Update Date: 11/03/2025
Certification Date: 11/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

908 E 16TH ST STE B
WILMINGTON DE
19802-5145
US

IV. Provider business mailing address

PO BOX 151
NEW CASTLE DE
19720-0151
US

V. Phone/Fax

Practice location:
  • Phone: 302-575-1414
  • Fax:
Mailing address:
  • Phone: 302-652-2455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberLG-0013363
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: