Provider Demographics
NPI:1982058681
Name:MWAURA, PHYLLIS
Entity Type:Individual
Prefix:MS
First Name:PHYLLIS
Middle Name:
Last Name:MWAURA
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 1:309 SANFORD RD
Mailing Address - Street 2:
Mailing Address - City:UPPER DARBY
Mailing Address - State:PA
Mailing Address - Zip Code:19082-4716
Mailing Address - Country:US
Mailing Address - Phone:302-444-7000
Mailing Address - Fax:
Practice Address - Street 1:309 SANFORD RD
Practice Address - Street 2:
Practice Address - City:UPPER DARBY
Practice Address - State:PA
Practice Address - Zip Code:19082-4716
Practice Address - Country:US
Practice Address - Phone:302-444-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-19
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA42963601172V00000X, 251E00000X, 251T00000X, 332B00000X, 343900000X, 347C00000X, 372500000X, 385H00000X, 372600000X, 376J00000X, 376K00000X
253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No172V00000XOther Service ProvidersCommunity Health Worker
No251E00000XAgenciesHome Health
No251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347C00000XTransportation ServicesPrivate Vehicle
No372500000XNursing Service Related ProvidersChore Provider
No385H00000XRespite Care FacilityRespite Care
No372600000XNursing Service Related ProvidersAdult Companion
No376J00000XNursing Service Related ProvidersHomemaker
No376K00000XNursing Service Related ProvidersNurse's Aide