Healthcare Provider Details

I. General information

NPI: 1164050894
Provider Name (Legal Business Name): SHARON PRICE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2020
Last Update Date: 11/27/2023
Certification Date: 03/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6008 CREEDMOOR RD
RALEIGH NC
27612-2209
US

IV. Provider business mailing address

1404 BATTERY DR
RALEIGH NC
27610-2624
US

V. Phone/Fax

Practice location:
  • Phone: 919-844-4552
  • Fax:
Mailing address:
  • Phone: 919-413-6092
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License NumberNU000004
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: