Provider Demographics
NPI:1760635130
Name:DESILETS, PAUL ARMAND
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:ARMAND
Last Name:DESILETS
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 1:11615 NEW BOND ST
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22408-1864
Mailing Address - Country:US
Mailing Address - Phone:540-891-9565
Mailing Address - Fax:
Practice Address - Street 1:11615 NEW BOND ST
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22408-1864
Practice Address - Country:US
Practice Address - Phone:540-891-9565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-29
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2705 125500171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications