Healthcare Provider Details

I. General information

NPI: 1104738376
Provider Name (Legal Business Name): QDEISHA ROBERTSON CPSS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2118 S ASHLAND DR
BURLINGTON NC
27217-1847
US

IV. Provider business mailing address

2118 S ASHLAND DR
BURLINGTON NC
27217-1847
US

V. Phone/Fax

Practice location:
  • Phone: 919-259-3438
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: