Provider Demographics
NPI:1720708142
Name:POTTER, RASHEEDAH JEELAN
Entity Type:Individual
Prefix:
First Name:RASHEEDAH
Middle Name:JEELAN
Last Name:POTTER
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 1:502 GREENS BRANCH LN
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:DE
Mailing Address - Zip Code:19977-4100
Mailing Address - Country:US
Mailing Address - Phone:267-285-6676
Mailing Address - Fax:
Practice Address - Street 1:74 E GLENWOOD AVE
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:DE
Practice Address - Zip Code:19977-1002
Practice Address - Country:US
Practice Address - Phone:484-841-8924
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-29
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL1-0040342163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health