1629610753 NPI number — MISS DAESHA L PITTS (CPB) CERTIFIED PROF

Table of content: (NPI 1760447163)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629610753 NPI number — MISS DAESHA L PITTS (CPB) CERTIFIED PROF

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PITTS
Provider First Name:
DAESHA
Provider Middle Name:
L
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
(CPB) CERTIFIED PROF
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PITTS
Provider Other First Name:
DAESHA
Provider Other Middle Name:
L
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
(CPB) CERTIFIED PROF
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1629610753
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/10/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
312 THOMAS DAVIS DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLAYTON
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19938-2578
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-883-7787
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
511 E 12TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHESTER
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19013-6116
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-883-7787
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/10/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 374U00000X , with the licence number:  826112 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com