Provider Demographics
NPI:1932555018
Name:FRYE, ENDYA LANISSE (MD)
Entity Type:Individual
Prefix:DR
First Name:ENDYA
Middle Name:LANISSE
Last Name:FRYE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 N ELAM AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27403-1177
Mailing Address - Country:US
Mailing Address - Phone:336-299-3183
Mailing Address - Fax:336-299-1762
Practice Address - Street 1:510 N ELAM AVE STE 202
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27403-1142
Practice Address - Country:US
Practice Address - Phone:336-299-3183
Practice Address - Fax:336-299-1762
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-09
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC218108208000000X
NC2019-00639208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty