Individual
TAIRAE DESHAUN MONROE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRANIAL PROSTHESIS
Contact information
Practice address
6017 LAKEWAY DR, FAYETTEVILLE, NC 28306-9754
(757) 940-9878
Mailing address
6017 LAKEWAY DR, FAYETTEVILLE, NC 28306-9754
(757) 940-9878
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
—
—
1744P3200X
Prosthetics Case Management
—
—
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Enumeration date
07/22/2025
Last updated
07/22/2025
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