Healthcare Provider Details

I. General information

NPI: 1467226688
Provider Name (Legal Business Name): DESHAWN MCNEIL CNS, NBC-HWC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2023
Last Update Date: 11/08/2023
Certification Date: 11/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 E WENDOVER AVE
GREENSBORO NC
27405-6713
US

IV. Provider business mailing address

1100 E WENDOVER AVE
GREENSBORO NC
27405-6713
US

V. Phone/Fax

Practice location:
  • Phone: 336-641-4135
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: