Provider Demographics
NPI:1467906198
Name:DELILLYE, NIKO
Entity Type:Individual
Prefix:
First Name:NIKO
Middle Name:
Last Name:DELILLYE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3476 WOODBAUGH DR
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23321-4826
Mailing Address - Country:US
Mailing Address - Phone:757-320-7496
Mailing Address - Fax:
Practice Address - Street 1:3476 WOODBAUGH DR
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23321-4826
Practice Address - Country:US
Practice Address - Phone:757-320-7496
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-11
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1600804172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver