Healthcare Provider Details

I. General information

NPI: 1619074408
Provider Name (Legal Business Name): BRUNILDA CORDERO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/02/2025
Certification Date: 07/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 ROBESON ST SUITE 410
FAYETTEVILLE NC
28301-5552
US

IV. Provider business mailing address

101 ROBESON ST SUITE 410
FAYETTEVILLE NC
28301-5552
US

V. Phone/Fax

Practice location:
  • Phone: 910-615-1885
  • Fax: 910-321-6254
Mailing address:
  • Phone: 910-615-1885
  • Fax: 910-321-6254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License Number27876
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number2005-01160
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: