Provider Demographics
NPI:1851371447
Name:DEYANEZ, NIDIA (MD)
Entity Type:Individual
Prefix:
First Name:NIDIA
Middle Name:
Last Name:DEYANEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 PENNSYLVANIA AVE
Mailing Address - Street 2:STE 110
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19806-1401
Mailing Address - Country:US
Mailing Address - Phone:302-655-2991
Mailing Address - Fax:302-655-1944
Practice Address - Street 1:2401 PENNSYLVANIA AVE
Practice Address - Street 2:STE 110
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19806-1401
Practice Address - Country:US
Practice Address - Phone:302-655-2991
Practice Address - Fax:302-655-1944
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-19
Last Update Date:2009-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC100020592084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEB66534Medicare UPIN
DE010956C60Medicare PIN