Provider Demographics
NPI:1841730132
Name:STARADUMSKY, TABITHA BROOK (PA-C)
Entity type:Individual
Prefix:
First Name:TABITHA
Middle Name:BROOK
Last Name:STARADUMSKY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:TABITHA
Other - Middle Name:
Other - Last Name:BEDNARCZYK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:202 VILLAGE RD NE
Mailing Address - Street 2:
Mailing Address - City:LELAND
Mailing Address - State:NC
Mailing Address - Zip Code:28451-7414
Mailing Address - Country:US
Mailing Address - Phone:910-371-3600
Mailing Address - Fax:
Practice Address - Street 1:40 RAVENSWOOD RD
Practice Address - Street 2:
Practice Address - City:HAMPSTEAD
Practice Address - State:NC
Practice Address - Zip Code:28443-4022
Practice Address - Country:US
Practice Address - Phone:910-772-6558
Practice Address - Fax:910-270-2290
Is Sole Proprietor?:No
Enumeration Date:2017-03-06
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-07044363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant