Healthcare Provider Details

I. General information

NPI: 1821952532
Provider Name (Legal Business Name): SHIRA ROSEBORO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3618 RIVER WATCH LN
FRANKLINTON NC
27525-7051
US

IV. Provider business mailing address

2903 BAINBRIDGE DR APT L
DURHAM NC
27713-5433
US

V. Phone/Fax

Practice location:
  • Phone: 919-213-0465
  • Fax:
Mailing address:
  • Phone: 984-484-8197
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number000245760004
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: