Healthcare Provider Details

I. General information

NPI: 1851150593
Provider Name (Legal Business Name): DELILA LYN BACKUS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2024
Last Update Date: 03/15/2024
Certification Date: 03/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18288 N US HIGHWAY 41
LUTZ FL
33549-4400
US

IV. Provider business mailing address

14059 RIVEREDGE DR
TAMPA FL
33637-1038
US

V. Phone/Fax

Practice location:
  • Phone: 813-527-9638
  • Fax:
Mailing address:
  • Phone: 727-337-6292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: