Provider Demographics
NPI:1811764996
Name:ORUADEBAYO, TARERI
Entity type:Individual
Prefix:
First Name:TARERI
Middle Name:
Last Name:ORUADEBAYO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2166 TROLLINGER DR
Mailing Address - Street 2:
Mailing Address - City:CATAWBA
Mailing Address - State:NC
Mailing Address - Zip Code:28609-9544
Mailing Address - Country:US
Mailing Address - Phone:704-963-7142
Mailing Address - Fax:
Practice Address - Street 1:2166 TROLLINGER DR
Practice Address - Street 2:
Practice Address - City:CATAWBA
Practice Address - State:NC
Practice Address - Zip Code:28609-9544
Practice Address - Country:US
Practice Address - Phone:704-963-7142
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-07
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver