Individual
TYIA SHAY CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3746 VEST MILL RD, WINSTON SALEM, NC 27103-2912
(336) 713-0024
Mailing address
3746 VEST MILL RD, WINSTON SALEM, NC 27103-2912
(336) 713-0024
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
2021-01599
NC
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/29/2018
Last updated
12/14/2023
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