Healthcare Provider Details

I. General information

NPI: 1033922356
Provider Name (Legal Business Name): TAYITA ABUDU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2025
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67 PRESIDENT ST
CHARLESTON SC
29425-5712
US

IV. Provider business mailing address

67 PRESIDENT ST
CHARLESTON SC
29425-8905
US

V. Phone/Fax

Practice location:
  • Phone: 843-792-0192
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number97369
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: