Healthcare Provider Details

I. General information

NPI: 1124982905
Provider Name (Legal Business Name): ANDREA NATALY CANTU
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10223 MCLNTYRE RIDGE RD
PINEVILLE NC
28134
US

IV. Provider business mailing address

211 E PARK AVE
CHARLOTTE NC
28203-4749
US

V. Phone/Fax

Practice location:
  • Phone: 704-520-0955
  • Fax:
Mailing address:
  • Phone: 731-432-0663
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: