Healthcare Provider Details

I. General information

NPI: 1679481451
Provider Name (Legal Business Name): EBONY MCCASKILL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 PEMBROKE RD APT 4
GASTONIA NC
28054-4707
US

IV. Provider business mailing address

2601 PEMBROKE RD APT 4
GASTONIA NC
28054-4707
US

V. Phone/Fax

Practice location:
  • Phone: 346-262-4305
  • Fax:
Mailing address:
  • Phone: 346-262-4305
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: