| Provider / Organization | NPI | Date Certified |
|---|---|---|
| TAJA KEYARA GASKINS | 1184212615 | 2021-01-10 |
| Entity Type | Individual |
| Provider Name | Miss Taja Keyara Gaskins LMT |
| Practice Office Address | 2601 FIRELIGHT RD RALEIGH, NC US |
| Practice Office Telephone | 9193455408 |
| Mailing Address | 2601 FIRELIGHT RD RALEIGH, NC 276105815 US |
| Business Telephone | 9193455408 |
| Code | License No | State |
|---|---|---|
| 225700000X PRIMARY | 18735 | NC |