Healthcare Provider Details

I. General information

NPI: 1972040848
Provider Name (Legal Business Name): PHYCINITY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2017
Last Update Date: 11/30/2025
Certification Date: 11/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2277 NC 24-87
CAMERON NC
28326-6687
US

IV. Provider business mailing address

450 CARTHAGE ST UNIT 158
CAMERON NC
28326-5106
US

V. Phone/Fax

Practice location:
  • Phone: 919-373-3636
  • Fax: 919-867-3493
Mailing address:
  • Phone: 919-373-3636
  • Fax: 919-867-3493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number216754
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number216754
License Number StateNC

VIII. Authorized Official

Name: DR. OMAR LEONEL CABAN
Title or Position: CMO
Credential: M.D.
Phone: 919-373-3636