Provider Demographics
NPI:1801497631
Name:UNDERWOOD, DEANNA RENEE
Entity type:Individual
Prefix:
First Name:DEANNA
Middle Name:RENEE
Last Name:UNDERWOOD
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 1:2502 SILVERSIDE RD STE 9
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19810-3740
Mailing Address - Country:US
Mailing Address - Phone:302-375-6533
Mailing Address - Fax:
Practice Address - Street 1:2502 SILVERSIDE RD STE 9
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19810-3740
Practice Address - Country:US
Practice Address - Phone:302-375-6533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-06
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEMT-0003483225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist