Healthcare Provider Details

I. General information

NPI: 1811162340
Provider Name (Legal Business Name): ALEATHA D DESHIELDS THOMAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2008
Last Update Date: 04/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DUMC 3885 M04 DAVISON BLDG
DURHAM NC
27710-0001
US

IV. Provider business mailing address

DUMC 3885 M04 DAVISON BLDG
DURHAM NC
27710-0001
US

V. Phone/Fax

Practice location:
  • Phone: 919-684-2474
  • Fax: 919-681-8496
Mailing address:
  • Phone: 919-684-2474
  • Fax: 919-681-8496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License NumberT36435
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: