Provider Demographics
NPI:1962962589
Name:BASILIOS, DELANEY (PA-C)
Entity type:Individual
Prefix:
First Name:DELANEY
Middle Name:
Last Name:BASILIOS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 JEFFERSON BLVD STE H
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02888-3854
Mailing Address - Country:US
Mailing Address - Phone:401-384-7406
Mailing Address - Fax:
Practice Address - Street 1:110 JEFFERSON BLVD STE H
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02888-3854
Practice Address - Country:US
Practice Address - Phone:401-384-7406
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-20
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical