Provider Demographics
NPI:1508053133
Name:DERBYSHIRE, LINDA GERARD (IBCLC)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:GERARD
Last Name:DERBYSHIRE
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1740 SOUTH ST.
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19146
Mailing Address - Country:US
Mailing Address - Phone:610-316-9157
Mailing Address - Fax:215-735-5690
Practice Address - Street 1:1740 SOUTH ST.
Practice Address - Street 2:SUITE #301
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19146
Practice Address - Country:US
Practice Address - Phone:610-316-9157
Practice Address - Fax:215-735-5690
Is Sole Proprietor?:No
Enumeration Date:2007-09-27
Last Update Date:2013-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA100-16351174400000X
174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
No174400000XOther Service ProvidersSpecialist