Healthcare Provider Details

I. General information

NPI: 1427755438
Provider Name (Legal Business Name): KAMERON AYMAN KADDOURI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2023
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 HIGHWOODS BLVD STE 115
RALEIGH NC
27604-1033
US

IV. Provider business mailing address

2821 WILSHIRE HILL DR UNIT 119
RALEIGH NC
27604-5304
US

V. Phone/Fax

Practice location:
  • Phone: 984-370-9240
  • Fax:
Mailing address:
  • Phone: 828-808-4849
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: