Provider Demographics
NPI:1699750729
Name:DETROYE, ALISHA T (PAC)
Entity type:Individual
Prefix:
First Name:ALISHA
Middle Name:T
Last Name:DETROYE
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1701 WESTCHESTER DR
Mailing Address - Street 2:SUITE 850
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27262-7008
Mailing Address - Country:US
Mailing Address - Phone:336-802-2536
Mailing Address - Fax:336-802-2534
Practice Address - Street 1:905 PHILLIPS AVE
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27262-7075
Practice Address - Country:US
Practice Address - Phone:336-802-2040
Practice Address - Fax:336-802-2041
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2013-08-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC104035363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7264734OtherAETNA
NCD5159OtherMEDCOST
NCD5159OtherMEDCOST
NC2760946Medicare PIN
NCP00159778Medicare PIN