Healthcare Provider Details

I. General information

NPI: 1417797341
Provider Name (Legal Business Name): NISHA PAUDEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2024
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3020 S MIAMI BLVD STE A
DURHAM NC
27703-0965
US

IV. Provider business mailing address

3020 S MIAMI BLVD STE A
DURHAM NC
27703-0965
US

V. Phone/Fax

Practice location:
  • Phone: 919-598-9900
  • Fax: 919-598-9500
Mailing address:
  • Phone: 919-598-9900
  • Fax: 919-598-9500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number14919
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: