Healthcare Provider Details

I. General information

NPI: 1558195701
Provider Name (Legal Business Name): ABHAYA PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2024
Last Update Date: 07/31/2025
Certification Date: 07/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3710 UNIVERSITY DR STE 100
DURHAM NC
27707-6208
US

IV. Provider business mailing address

3710 UNIVERSITY DR STE 100
DURHAM NC
27707-6208
US

V. Phone/Fax

Practice location:
  • Phone: 919-906-4390
  • Fax: 919-287-2707
Mailing address:
  • Phone: 919-906-4390
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. MATHEW RYAN O'CONNOR
Title or Position: OWNER/ CEO
Credential: LCMHC, LCAS, CCS
Phone: 646-872-7527