Healthcare Provider Details

I. General information

NPI: 1639087620
Provider Name (Legal Business Name): MFYSL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 CONCORD PIKE
WILMINGTON DE
19803-3612
US

IV. Provider business mailing address

1601 CONCORD PIKE STE 60
WILMINGTON DE
19803-3630
US

V. Phone/Fax

Practice location:
  • Phone: 302-238-6476
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DAWN MOORE
Title or Position: OWNER/CLINICIAN
Credential: APRN-WHNP, PMHNP, CN
Phone: 302-220-3429