Healthcare Provider Details

I. General information

NPI: 1265309827
Provider Name (Legal Business Name): LYNDSEY MICHELLE DEGARO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2025
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4420 LAKE BOONE TRL
RALEIGH NC
27607-7505
US

IV. Provider business mailing address

2800 BLUE RIDGE RD STE 300
RALEIGH NC
27607-6476
US

V. Phone/Fax

Practice location:
  • Phone: 919-784-3100
  • Fax:
Mailing address:
  • Phone: 513-526-3034
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-16177
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: