Healthcare Provider Details

I. General information

NPI: 1548165533
Provider Name (Legal Business Name): MR. TASHEEM MALIK HALL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2026
Last Update Date: 10/10/2026
Certification Date: 10/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1031 PEMBERTON HILL RD STE 102
APEX NC
27502-4278
US

IV. Provider business mailing address

4761 COURTNEY LN APT B
RALEIGH NC
27616-5241
US

V. Phone/Fax

Practice location:
  • Phone: 347-626-9638
  • Fax:
Mailing address:
  • Phone: 347-626-9638
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: