Healthcare Provider Details

I. General information

NPI: 1013834928
Provider Name (Legal Business Name): JAYDEN BUCKLEY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2609 N DUKE ST STE 603
DURHAM NC
27704-3019
US

IV. Provider business mailing address

5526 RED ROBIN RD
RALEIGH NC
27613-7065
US

V. Phone/Fax

Practice location:
  • Phone: 845-779-2664
  • Fax:
Mailing address:
  • Phone: 845-779-2664
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number943321381
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: