MEDICARE: ASHLEY ROYAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	1-19-39060	NC

General Provider Information

NPI Number	:	1356876361
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY ROYAL

Provider Business Mailing Address
First Line	:	1816 THORPSHIRE DR
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27615-3735
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3041 BERKS WAY STE 203
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27614-6777
Country	:	US
Telephone Number	:	919-429-8338
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/27/2017
Last Update Date	:	03/19/2020

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Directions to “ ASHLEY ROYAL ” Practice Location

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