Provider Demographics
NPI:1538040431
Name:MIZELLE, DELANEY
Entity type:Individual
Prefix:
First Name:DELANEY
Middle Name:
Last Name:MIZELLE
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 1:1600 MARINA RD UNIT 323A
Mailing Address - Street 2:
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063-6920
Mailing Address - Country:US
Mailing Address - Phone:321-419-4519
Mailing Address - Fax:
Practice Address - Street 1:1600 MARINA RD UNIT 323A
Practice Address - Street 2:
Practice Address - City:IRMO
Practice Address - State:SC
Practice Address - Zip Code:29063-6920
Practice Address - Country:US
Practice Address - Phone:321-419-4519
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-09
Last Update Date:2025-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer