Healthcare Provider Details

I. General information

NPI: 1497101943
Provider Name (Legal Business Name): KIRAN HANSBERRY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KIRAN C SIDHWANI

II. Dates (important events)

Enumeration Date: 05/13/2016
Last Update Date: 10/03/2026
Certification Date: 10/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7048 KNIGHTDALE BLVD STE 220C
KNIGHTDALE NC
27545-8894
US

IV. Provider business mailing address

1205 TROTTER BLUFFS DR
HOLLY SPRINGS NC
27540-9149
US

V. Phone/Fax

Practice location:
  • Phone: 912-223-2037
  • Fax:
Mailing address:
  • Phone: 912-223-2037
  • Fax: 984-500-1863

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number18857
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number126450
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: