Provider Demographics
NPI:1982241113
Name:PRASAD, GEETA SHELLY
Entity Type:Individual
Prefix:
First Name:GEETA
Middle Name:SHELLY
Last Name:PRASAD
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 1:5700 KIRKWOOD HWY STE 204
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-4884
Mailing Address - Country:US
Mailing Address - Phone:302-709-1303
Mailing Address - Fax:
Practice Address - Street 1:640 RAVENGLASS DRIVE
Practice Address - Street 2:
Practice Address - City:TOWNSEND
Practice Address - State:DE
Practice Address - Zip Code:19734-1973
Practice Address - Country:US
Practice Address - Phone:347-257-4407
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-06
Last Update Date:2019-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical