Healthcare Provider Details

I. General information

NPI: 1104893064
Provider Name (Legal Business Name): NESTOR HERMINIO PAONESSA MS, LAT, ATC, CSCS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 12/07/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2402 PINEWAY DR
BURLINGTON NC
27215-4438
US

IV. Provider business mailing address

3701 COTSWOLD TER UNIT 9L
GREENSBORO NC
27410-8900
US

V. Phone/Fax

Practice location:
  • Phone: 336-584-9848
  • Fax:
Mailing address:
  • Phone: 336-404-0832
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number0954
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: