Provider Demographics
NPI:1346968229
Name:WANSHIYA, HERMAN RICHARD
Entity Type:Individual
Prefix:
First Name:HERMAN
Middle Name:RICHARD
Last Name:WANSHIYA
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 1:1940 DAISY ST
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27107-4304
Mailing Address - Country:US
Mailing Address - Phone:336-529-3898
Mailing Address - Fax:
Practice Address - Street 1:1940 DAISY ST
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27107-4304
Practice Address - Country:US
Practice Address - Phone:336-529-3893
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-17
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health