Healthcare Provider Details

I. General information

NPI: 1053987552
Provider Name (Legal Business Name): STRIDEWELL HEALTHCARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2021
Last Update Date: 09/13/2023
Certification Date: 04/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10801 JOHNSTON RD STE 207
CHARLOTTE NC
28226-0920
US

IV. Provider business mailing address

5710 EL CAMPO CT
CHARLOTTE NC
28277-1842
US

V. Phone/Fax

Practice location:
  • Phone: 980-349-8978
  • Fax: 870-408-3957
Mailing address:
  • Phone: 870-702-1465
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. BAMIDELE A AJAYI
Title or Position: OWNER
Credential: MD
Phone: 870-702-1465