Individual
DR. SHANTA MOTAMED
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DC
Contact information
Practice address
515 W MAIN ST, MOUNT OLIVE, NC 28365-1903
(919) 658-0003
Mailing address
6336 WAKEFALLS DR, WAKE FOREST, NC 27587-6264
(919) 417-6465
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
5373
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5373
—
NC
Enumeration date
07/16/2021
Last updated
07/16/2021
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