Healthcare Provider Details

I. General information

NPI: 1073454344
Provider Name (Legal Business Name): NAKIYAH E MOSELY-CULLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2026
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 BAILY RD
LANSDOWNE PA
19050-2801
US

IV. Provider business mailing address

261 S 58TH ST
PHILADELPHIA PA
19139-3811
US

V. Phone/Fax

Practice location:
  • Phone: 856-436-0016
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberSW140851
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: