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NPI Code Detail

MEDICARE: TANZANIAH FAULCON

MEDICARE: TANZANIAH FAULCON
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
1106S00000XBehavior TechnicianNC

General Provider Information

NPI Number : 1518824648
Entity Type Code : Individual
Provider Name (Legal Business Name) : TANZANIAH FAULCON
Provider Business Mailing Address
First Line : 429 NEW HOPE ST
Second Line :
City : ROANOKE RAPIDS
State : NC
Zip : 27870-8279
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 120 E BELLE ST
Second Line :
City : HENDERSON
State : NC
Zip : 27536-4502
Country : US
Telephone Number : 252-572-2933
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/09/2026
Last Update Date : 01/09/2026

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Directions to “ TANZANIAH FAULCON ” Practice Location

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