Healthcare Provider Details

I. General information

NPI: 1396669784
Provider Name (Legal Business Name): DARIA BULDAKOVA
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3360 MISSION OLIVE PL
NEW HILL NC
27562-7700
US

IV. Provider business mailing address

3360 MISSION OLIVE PL
NEW HILL NC
27562-7700
US

V. Phone/Fax

Practice location:
  • Phone: 984-377-0234
  • Fax:
Mailing address:
  • Phone: 984-377-0234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171R00000X
TaxonomyInterpreter
License Number11223344
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: