Basic Information
| Provider Information | |||||||||
| NPI: | 1659415529 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | STATE OF DELAWARE | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | INDIAN RIVER SCHOOL DISTRICT | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 31 HOSIER ST | ||||||||
| Address2: | |||||||||
| City: | SELBYVILLE | ||||||||
| State: | DE | ||||||||
| PostalCode: | 199759300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3024361000 | ||||||||
| FaxNumber: | 3024361034 | ||||||||
| Practice Location | |||||||||
| Address1: | 31 HOSIER ST | ||||||||
| Address2: | |||||||||
| City: | SELBYVILLE | ||||||||
| State: | DE | ||||||||
| PostalCode: | 199759300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3024361000 | ||||||||
| FaxNumber: | 3024361034 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/16/2007 | ||||||||
| LastUpdateDate: | 07/08/2008 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | BUNTING | ||||||||
| AuthorizedOfficialFirstName: | SUSAN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | SUPERINTENDENT | ||||||||
| AuthorizedOfficialTelephone: | 3024361000 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251300000X | Y | Agencies | Local Education Agency (LEA) |
No ID Information.