Healthcare Provider Details

I. General information

NPI: 1750268330
Provider Name (Legal Business Name): TIFFANY NEAL
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2025
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1920 NC-54 STE 240, 360,
DURHAM NC
27713
US

IV. Provider business mailing address

2101 N CHURCH ST
GREENSBORO NC
27405-5671
US

V. Phone/Fax

Practice location:
  • Phone: 919-378-1340
  • Fax:
Mailing address:
  • Phone: 704-780-4271
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number4480
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: