Healthcare Provider Details

I. General information

NPI: 1750211744
Provider Name (Legal Business Name): KYNNEDI SANAA HARRIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 RACINE DR STE 100
WILMINGTON NC
28403-8703
US

IV. Provider business mailing address

1921 CASTLE ST
WILMINGTON NC
28403-2105
US

V. Phone/Fax

Practice location:
  • Phone: 910-971-0025
  • Fax:
Mailing address:
  • Phone: 910-264-9586
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: