Provider Demographics
NPI:1942826516
Name:WHITE, SHONDELL
Entity Type:Individual
Prefix:
First Name:SHONDELL
Middle Name:
Last Name:WHITE
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 1:1114 S DUPONT HWY STE 105
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19901-4401
Mailing Address - Country:US
Mailing Address - Phone:302-442-6194
Mailing Address - Fax:
Practice Address - Street 1:1423 CAPITOL TRAIL ROAD
Practice Address - Street 2:SUITE 1302
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19711
Practice Address - Country:US
Practice Address - Phone:302-565-6697
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-19
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEQ3-0000085Medicaid