Provider Demographics
NPI:1659982031
Name:ONYEABO, STANLEY OKEZIE
Entity Type:Individual
Prefix:
First Name:STANLEY
Middle Name:OKEZIE
Last Name:ONYEABO
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 1:5902 PADUCAH DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-1174
Mailing Address - Country:US
Mailing Address - Phone:919-389-3454
Mailing Address - Fax:
Practice Address - Street 1:2421 TIMBER DR STE 211
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27604-2265
Practice Address - Country:US
Practice Address - Phone:919-389-3454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-11
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC5372253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care