Healthcare Provider Details

I. General information

NPI: 1427424365
Provider Name (Legal Business Name): MR. JOSEPH DELSANTO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2015
Last Update Date: 08/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 S KINGS DR
CHARLOTTE NC
28204-2932
US

IV. Provider business mailing address

601 S KINGS DR
CHARLOTTE NC
28204-2932
US

V. Phone/Fax

Practice location:
  • Phone: 704-333-9055
  • Fax: 704-333-9056
Mailing address:
  • Phone: 704-333-9055
  • Fax: 704-333-9056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number1403
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: