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General NPI Number Information
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NPI Number | 1528928835
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Entity Type | Organization
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Legal Business Name | NEOTERIC VITALITY PRIMARY CARE AND AESTHETICS
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Dates
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Enumeration Date | 11/18/2025
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Last Update Date | 11/18/2025
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Provider Practice Location Address
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Address Line | 601 TOWER LN STE 100
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City | MIDDLETOWN
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State | DE
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Zip | 19709-1763
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Country | US
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Telephone | 302-374-0308
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Fax | 302-204-6306
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Provider Business Mailing Address
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Address Line | 601 TOWER LN STE 100
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City | MIDDLETOWN
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State | DE
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Zip | 19709-1763
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Country | US
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Telephone | 302-374-0308
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Fax | 302-204-6306
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | JANIKA WALLACE
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Credential | DO
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Telephone | 302-374-0308
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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