Provider Demographics
NPI:1629610753
Name:PITTS, DAESHA L ((CPB) CERTIFIED PROF)
Entity Type:Individual
Prefix:MISS
First Name:DAESHA
Middle Name:L
Last Name:PITTS
Suffix:
Gender:F
Credentials:(CPB) CERTIFIED PROF
Other - Prefix:MISS
Other - First Name:DAESHA
Other - Middle Name:L
Other - Last Name:PITTS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:(CPB) CERTIFIED PROF
Mailing Address - Street 1:312 THOMAS DAVIS DR
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:DE
Mailing Address - Zip Code:19938-2578
Mailing Address - Country:US
Mailing Address - Phone:302-883-7787
Mailing Address - Fax:
Practice Address - Street 1:511 E 12TH ST
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19013-6116
Practice Address - Country:US
Practice Address - Phone:302-883-7787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-10
Last Update Date:2019-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA826112374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide