Healthcare Provider Details

I. General information

NPI: 1558501585
Provider Name (Legal Business Name): ANDREW STARK PRESTON PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2009
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5015 SOUTHPARK DR STE 250
DURHAM NC
27713-7736
US

IV. Provider business mailing address

7419 MONTIBILLO PKWY
DURHAM NC
27713-8891
US

V. Phone/Fax

Practice location:
  • Phone: 984-287-8998
  • Fax:
Mailing address:
  • Phone: 984-287-8998
  • Fax: 984-250-7505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberNC3797
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: