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General NPI Number Information
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NPI Number | 1487422630
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Entity Type | Organization
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Legal Business Name | DELTA DIALYSIS LLC
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Dates
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Enumeration Date | 12/18/2023
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Last Update Date | 12/18/2023
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Provider Practice Location Address
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Address Line | 900 PLYMOUTH AVE
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City | ORLANDO
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State | FL
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Zip | 32805-3744
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Country | US
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Telephone | 407-824-1014
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Fax | 407-247-6910
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Provider Business Mailing Address
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Address Line | 900 PLYMOUTH AVE
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City | ORLANDO
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State | FL
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Zip | 32805-3744
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Country | US
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Telephone | 407-451-1208
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | NDIDI NWAMU
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Credential | DO
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Telephone | 407-457-7808
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QE0700X
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Taxonomy Name | End-Stage Renal Disease (ESRD) Treatment Clinic/Center
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License Number |
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License Number State |
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