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General NPI Number Information
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NPI Number | 1104893064
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Entity Type | Individual
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Provider Name | NESTOR HERMINIO PAONESSA MS, LAT, ATC, CSCS
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Gender | Male
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Dates
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Enumeration Date | 02/28/2006
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Last Update Date | 12/07/2025
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Provider Practice Location Address
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Address Line | 2402 PINEWAY DR
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City | BURLINGTON
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State | NC
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Zip | 27215-4438
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Country | US
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Telephone | 336-584-9848
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Fax |
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Provider Business Mailing Address
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Address Line | 3701 COTSWOLD TER UNIT 9L
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City | GREENSBORO
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State | NC
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Zip | 27410-8900
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Country | US
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Telephone | 336-404-0832
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 0954
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License Number State | NC
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