New Name Born LLC

Primary specialty

Peer SpecialistTaxonomy code 175T00000X

Legal business name

NEW NAME BORN LLC

Practice address

11124 Front Porch Ave Apt 21107
Charlotte, NC 28227-0049

Phone

(704) 777-5710

NPI assigned

Jul 12, 2024

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Cypriel Fidelis NwaforNPI 1376388678

Title

Ceo

Phone

(704) 777-5710

Specialties & licenses 1

Addresses

Other names 1

• Newnameborn Doing business as

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Cypriel Fidelis Nwafor

  • Peer Specialist
  • Charlotte, NC
  • NPI 1376388678
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1720742400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722384000000",
    "number": "1114764420",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11124 FRONT PORCH AVE APT 21107",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282270049",
            "telephone_number": "704-777-5710"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11124 FRONT PORCH AVE APT 21107",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282270049",
            "telephone_number": "704-777-5710"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEW NAME BORN LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-07-12",
        "last_updated": "2024-07-31",
        "certification_date": "2024-07-31",
        "status": "A",
        "authorized_official_last_name": "NWAFOR",
        "authorized_official_first_name": "CYPRIEL",
        "authorized_official_middle_name": "FIDELIS",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "704-777-5710",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "175T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Peer Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Newnameborn",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Newnameborn",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Peer Specialist in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Peer Specialist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.