Healthcare Provider Details

I. General information

NPI: 1801750963
Provider Name (Legal Business Name): CASASHANTI WINSTON SALEM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2025
Last Update Date: 12/12/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 N LIBERTY ST 333
WINSTON SALEM NC
27101-2911
US

IV. Provider business mailing address

550 N LIBERTY ST BOX 333
WINSTON SALEM NC
27101-2911
US

V. Phone/Fax

Practice location:
  • Phone: 336-837-6748
  • Fax:
Mailing address:
  • Phone: 336-837-6748
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name: MR. ZACHARY CHARLES VANDYNE
Title or Position: OWNER
Credential:
Phone: 336-837-6748