Provider Demographics
NPI:1013290337
Name:JOOMUN, DEELSHAD
Entity Type:Individual
Prefix:
First Name:DEELSHAD
Middle Name:
Last Name:JOOMUN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1229 CHESTNUT ST
Mailing Address - Street 2:ADELPHIA HOUSE, APT 419
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-4140
Mailing Address - Country:US
Mailing Address - Phone:646-245-3186
Mailing Address - Fax:
Practice Address - Street 1:1229 CHESTNUT ST
Practice Address - Street 2:ADELPHIA HOUSE, APT 419
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-4140
Practice Address - Country:US
Practice Address - Phone:646-245-3186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-22
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program