Healthcare Provider Details

I. General information

NPI: 1144028556
Provider Name (Legal Business Name): EVOLVE PSYCHIATRY NC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2025
Last Update Date: 05/13/2025
Certification Date: 05/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1508 MEDICAL CENTER DR
WILMINGTON NC
28401-7507
US

IV. Provider business mailing address

5550 MERRICK RD
MASSAPEQUA NY
11758-6238
US

V. Phone/Fax

Practice location:
  • Phone: 631-673-3233
  • Fax: 888-571-1288
Mailing address:
  • Phone: 631-673-2333
  • Fax: 888-571-1288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. PRIYADARSHAN BAJPAYI
Title or Position: OWNER
Credential: MD
Phone: 631-673-3233