Healthcare Provider Details

I. General information

NPI: 1831002443
Provider Name (Legal Business Name): TRACY DELAUS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 OAKBRIAR CT APT 27
PENFIELD NY
14526-2672
US

IV. Provider business mailing address

114 OAKBRIAR CT APT 27
PENFIELD NY
14526-2672
US

V. Phone/Fax

Practice location:
  • Phone: 585-430-8016
  • Fax:
Mailing address:
  • Phone: 585-430-8016
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number057532
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: