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General NPI Number Information
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NPI Number | 1144420993
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Entity Type | Individual
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Provider Name | DESHANDRA MUNSAMY RAIDOO MD., PHD
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Gender | Male
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Dates
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Enumeration Date | 07/19/2007
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Last Update Date | 03/01/2012
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Provider Practice Location Address
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Address Line | 2300 RAMSEY ST US DEPARTMENT OF VETERANS AFFAIRS
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City | FAYETTEVILLE
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State | NC
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Zip | 28301-3856
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Country | US
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Telephone | 910-488-2120
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Fax | 910-822-7920
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Provider Business Mailing Address
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Address Line | PO BOX 9876
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City | FAYETTEVILLE
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State | NC
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Zip | 28311-9093
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Country | US
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Telephone | 605-929-4603
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | D0072629
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License Number State | MD
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