Provider Demographics
NPI:1689993941
Name:CAIN, DELTA SHAMEL (BS)
Entity Type:Individual
Prefix:
First Name:DELTA
Middle Name:SHAMEL
Last Name:CAIN
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2206 BETHABARA POINTE DR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-2783
Mailing Address - Country:US
Mailing Address - Phone:336-813-1791
Mailing Address - Fax:
Practice Address - Street 1:2206 BETHABARA POINTE DR
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-2783
Practice Address - Country:US
Practice Address - Phone:336-813-1791
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-26
Last Update Date:2010-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCCSC302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization