Provider Demographics
NPI:1295277754
Name:AYIVOR, DELPHINE SITSOFE
Entity type:Individual
Prefix:MS
First Name:DELPHINE
Middle Name:SITSOFE
Last Name:AYIVOR
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 1:9264 GARRETT LAKE DR
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31820-4446
Mailing Address - Country:US
Mailing Address - Phone:732-687-2012
Mailing Address - Fax:
Practice Address - Street 1:9264 GARRETT LAKE DR
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:GA
Practice Address - Zip Code:31820-4446
Practice Address - Country:US
Practice Address - Phone:732-687-2012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-14
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN212661364SA2200X, 364SC2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
No364SC2300XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistChronic Care