Provider Demographics
NPI:1700074796
Name:DE JESUS-ALVELO, INDIRA (MD)
Entity Type:Individual
Prefix:DR
First Name:INDIRA
Middle Name:
Last Name:DE JESUS-ALVELO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:INDIRA
Other - Middle Name:
Other - Last Name:DE JESUS ALVELO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:200 HYGEIA DR STE 2300
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2049
Mailing Address - Country:US
Mailing Address - Phone:305-243-2742
Mailing Address - Fax:
Practice Address - Street 1:774 CHRISTIANA RD STE 201
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-4221
Practice Address - Country:US
Practice Address - Phone:302-623-3017
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-04
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-00127262084N0400X
PAMD4579382084N0400X
FLME1479632084N0400X
VA01012715742084N0400X
MO20230199382084N0400X
PR11782 I208600000X
PR17353208D00000X
ORMD2138902084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice