Provider Demographics
NPI:1376071589
Name:LEE, REQUITA MARIE DEMERY (MD)
Entity Type:Individual
Prefix:DR
First Name:REQUITA
Middle Name:MARIE DEMERY
Last Name:LEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:REQUITA
Other - Middle Name:MARIE
Other - Last Name:DEMERY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:536B SPRING FOREST RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-7237
Mailing Address - Country:US
Mailing Address - Phone:252-814-5214
Mailing Address - Fax:
Practice Address - Street 1:4106 SHIPYARD BOULEVARD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403
Practice Address - Country:US
Practice Address - Phone:910-858-5848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2021-011202084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry