Provider Demographics
NPI:1053001453
Name:BECTON, DEREK SHAJN
Entity type:Individual
Prefix:
First Name:DEREK
Middle Name:SHAJN
Last Name:BECTON
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 1:233 DOVE COTTAGE LN
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27519-0506
Mailing Address - Country:US
Mailing Address - Phone:919-438-2666
Mailing Address - Fax:
Practice Address - Street 1:539 KEISLER DR STE 203
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-9320
Practice Address - Country:US
Practice Address - Phone:919-438-2666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-09
Last Update Date:2023-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12933225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist