Healthcare Provider Details

I. General information

NPI: 1134030968
Provider Name (Legal Business Name): MR. CAMERON TYLER SULYA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

542 SUGAR COVE LN
CHAPEL HILL NC
27516-6320
US

IV. Provider business mailing address

925 SHELLBROOK CT APT 9
RALEIGH NC
27609-4290
US

V. Phone/Fax

Practice location:
  • Phone: 910-912-5192
  • Fax:
Mailing address:
  • Phone: 317-750-1338
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP023748
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: