Provider Demographics
NPI:1487014064
Name:KELETA, DESALE
Entity Type:Individual
Prefix:MR
First Name:DESALE
Middle Name:
Last Name:KELETA
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 1:35 NANCY LN
Mailing Address - Street 2:
Mailing Address - City:DOWNINGTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19335-2272
Mailing Address - Country:US
Mailing Address - Phone:267-240-0027
Mailing Address - Fax:484-237-8803
Practice Address - Street 1:35 NANCY LN
Practice Address - Street 2:
Practice Address - City:DOWNINGTOWN
Practice Address - State:PA
Practice Address - Zip Code:19335-2272
Practice Address - Country:US
Practice Address - Phone:267-240-0027
Practice Address - Fax:484-237-8803
Is Sole Proprietor?:No
Enumeration Date:2016-02-25
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator