Healthcare Provider Details

I. General information

NPI: 1508516725
Provider Name (Legal Business Name): TAWANDA ZINYANDU
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2022
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 SMITH CHURCH RD
ROANOKE RAPIDS NC
27870-4914
US

IV. Provider business mailing address

250 SMITH CHURCH RD
ROANOKE RAPIDS NC
27870-4914
US

V. Phone/Fax

Practice location:
  • Phone: 252-535-8011
  • Fax:
Mailing address:
  • Phone: 252-535-8011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2026-04012
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: