Healthcare Provider Details

I. General information

NPI: 1750066395
Provider Name (Legal Business Name): CAROLINA MEJIA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2023
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4819 EMPEROR BLVD STE 400
DURHAM NC
27703-5420
US

IV. Provider business mailing address

4575 SE DIXIE HWY
STUART FL
34997-6826
US

V. Phone/Fax

Practice location:
  • Phone: 185-583-2672
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: