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NPI Code Detail

MEDICARE: BREANNA PHULESAR

MEDICARE: BREANNA PHULESAR
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number : 1396497343
Entity Type Code : Individual
Provider Name (Legal Business Name) : BREANNA PHULESAR
Provider Business Mailing Address
First Line : 2999 PHILADELPHIA PIKE
Second Line :
City : CLAYMONT
State : DE
Zip : 19703-2507
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2999 PHILADELPHIA PIKE
Second Line :
City : CLAYMONT
State : DE
Zip : 19703-2507
Country : US
Telephone Number : 302-792-0700
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/21/2022
Last Update Date : 01/21/2022

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Directions to “ BREANNA PHULESAR ” Practice Location

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