Healthcare Provider Details

I. General information

NPI: 1073708491
Provider Name (Legal Business Name): SHRIDAYAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2007
Last Update Date: 02/17/2025
Certification Date: 02/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1324 JOHN KIRK DRIVE
CHARLOTTE NC
28262-0824
US

IV. Provider business mailing address

1324 JOHN KIRK DRIVE
CHARLOTTE NC
28262-0824
US

V. Phone/Fax

Practice location:
  • Phone: 704-510-0030
  • Fax: 704-510-5331
Mailing address:
  • Phone: 704-510-0030
  • Fax: 704-510-5331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number StateNC

VIII. Authorized Official

Name: MR. CHIGOZIE DAVID OGWUEGBU-STEPHENS
Title or Position: EXECUTIVE DIRECTOR
Credential: JD/MBA
Phone: 704-510-0030