Provider Demographics
NPI:1811434533
Name:CUSTIS, HAVEN STANLEY JR (RRT-NPS)
Entity type:Individual
Prefix:MR
First Name:HAVEN
Middle Name:STANLEY
Last Name:CUSTIS
Suffix:JR
Gender:M
Credentials:RRT-NPS
Other - Prefix:
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Mailing Address - Street 1:640 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19901
Mailing Address - Country:US
Mailing Address - Phone:302-744-6798
Mailing Address - Fax:302-735-3259
Practice Address - Street 1:640 S STATE ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19901-3530
Practice Address - Country:US
Practice Address - Phone:302-744-6798
Practice Address - Fax:302-735-3259
Is Sole Proprietor?:No
Enumeration Date:2017-01-20
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
DEC9-0000166227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered