Healthcare Provider Details

I. General information

NPI: 1700554292
Provider Name (Legal Business Name): PRISCILLA DAWN DELIZZA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2021
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

337 E JIMMIE LEEDS ROAD SUITE A
GALLOWAY NJ
08205
US

IV. Provider business mailing address

337 E JIMMIE LEEDS RD SUITE A
GALLOWAY NJ
08205
US

V. Phone/Fax

Practice location:
  • Phone: 800-805-6989
  • Fax:
Mailing address:
  • Phone: 800-805-6989
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBH008391
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: