Provider Demographics
NPI:1316812084
Name:ANDERSON, DARRYL J
Entity type:Individual
Prefix:
First Name:DARRYL
Middle Name:J
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8125 SYCAMORE CREEK DR APT K
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28273-6027
Mailing Address - Country:US
Mailing Address - Phone:717-678-9392
Mailing Address - Fax:
Practice Address - Street 1:8125 SYCAMORE CREEK DR APT K
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28273-6027
Practice Address - Country:US
Practice Address - Phone:717-678-9392
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-10
Last Update Date:2025-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No174400000XOther Service ProvidersSpecialist
No174H00000XOther Service ProvidersHealth Educator
No174V00000XOther Service ProvidersClinical Ethicist
No247000000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Health Information