Healthcare Provider Details

I. General information

NPI: 1588379812
Provider Name (Legal Business Name): ANDREW MEJIA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2023
Last Update Date: 01/20/2023
Certification Date: 01/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1413 BRISBANE WOODS WAY
CARY NC
27518-9252
US

IV. Provider business mailing address

1413 BRISBANE WOODS WAY
CARY NC
27518-9252
US

V. Phone/Fax

Practice location:
  • Phone: 813-506-3872
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number20565
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: