MEDICARE: NATAYA NIJA ADEBAYO PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	0010-16265	NC
2	390200000X	Student in an Organized Health Care Education/Training Program
3	2255A2300X	Athletic Trainer

General Provider Information

NPI Number	:	1306354469
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATAYA NIJA ADEBAYO PA-C

Provider Business Mailing Address
First Line	:	5221 PARAMOUNT PKWY STE 220
Second Line	:
City	:	MORRISVILLE
State	:	NC
Zip	:	27560-5490
Country	:	US
Telephone Number	:	984-215-4111
Fax Number	:

Provider Business Practice Location Address
First Line	:	4901 DAWN DR STE 2300
Second Line	:
City	:	LUMBERTON
State	:	NC
Zip	:	28360-8287
Country	:	US
Telephone Number	:	910-738-1065
Fax Number	:	910-738-5143

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/11/2018
Last Update Date	:	04/09/2026

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