Provider Demographics
NPI:1215346150
Name:VICTOR, ANESHA (NP)
Entity type:Individual
Prefix:
First Name:ANESHA
Middle Name:
Last Name:VICTOR
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 67526
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07101-8009
Mailing Address - Country:US
Mailing Address - Phone:302-266-9166
Mailing Address - Fax:866-670-8036
Practice Address - Street 1:94A OMEGA DR
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2066
Practice Address - Country:US
Practice Address - Phone:302-550-3484
Practice Address - Fax:302-556-3484
Is Sole Proprietor?:No
Enumeration Date:2014-08-05
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELP-0000112363LA2200X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health