Healthcare Provider Details

I. General information

NPI: 1174210629
Provider Name (Legal Business Name): SHARANDA KIRK PLACIDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHARANDA KIRK PLACIDE MD

II. Dates (important events)

Enumeration Date: 04/24/2023
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1638 OWEN DR
FAYETTEVILLE NC
28304-3424
US

IV. Provider business mailing address

1638 OWEN DR
FAYETTEVILLE NC
28304-3424
US

V. Phone/Fax

Practice location:
  • Phone: 910-615-0250
  • Fax:
Mailing address:
  • Phone: 910-615-0250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberLL90389
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMMD.90389
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: