Healthcare Provider Details

I. General information

NPI: 1710963897
Provider Name (Legal Business Name): CECILE EDITH NAYLOR PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2005
Last Update Date: 11/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

514 S STRATFORD RD SUITE 335
WINSTON SALEM NC
27103-1823
US

IV. Provider business mailing address

5032 MEADOW HILL CT
WINSTON SALEM NC
27106-4279
US

V. Phone/Fax

Practice location:
  • Phone: 336-464-7032
  • Fax: 336-464-7034
Mailing address:
  • Phone: 336-464-7032
  • Fax: 336-464-7034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number1450
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: