Healthcare Provider Details

I. General information

NPI: 1780595587
Provider Name (Legal Business Name): ALEXIS SHYDAE LAJEAN SWACKER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1412 SHARPE RD
BURLINGTON NC
27217-8774
US

IV. Provider business mailing address

1412 SHARPE RD
BURLINGTON NC
27217-8774
US

V. Phone/Fax

Practice location:
  • Phone: 855-832-6727
  • Fax: 772-675-9100
Mailing address:
  • Phone: 855-832-6727
  • Fax: 772-675-9100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-493772
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: