Provider Demographics
NPI:1669675484
Name:BRANDYWINE CENTER FOR WELLNESS
Entity Type:Organization
Organization Name:BRANDYWINE CENTER FOR WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SALVATORE
Authorized Official - Middle Name:
Authorized Official - Last Name:MULEH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:302-655-1437
Mailing Address - Street 1:515 W 18TH ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19802-4705
Mailing Address - Country:US
Mailing Address - Phone:302-655-1437
Mailing Address - Fax:302-655-1438
Practice Address - Street 1:515 W 18TH ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19802-4705
Practice Address - Country:US
Practice Address - Phone:302-655-1437
Practice Address - Fax:302-655-1438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE19632084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000432602Medicaid
DE0000432602Medicaid