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NPI Code Detail

MEDICARE: ABHAYA PLLC

MEDICARE: ABHAYA PLLC
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
1261QR0405XSubstance Use Disorder Rehabilitation Clinic/Center

General Provider Information

NPI Number : 1821715467
Entity Type Code : Organization
Provider Name (Legal Business Name) : ABHAYA PLLC
Provider Business Mailing Address
First Line : 3710 UNIVERSITY DR STE 100
Second Line :
City : DURHAM
State : NC
Zip : 27707-6208
Country : US
Telephone Number : 919-906-4390
Fax Number : 919-287-2707
Provider Business Practice Location Address
First Line : 3710 UNIVERSITY DR STE 100
Second Line :
City : DURHAM
State : NC
Zip : 27707-6208
Country : US
Telephone Number : 919-906-4390
Fax Number : 919-287-2707
Authorized Official
Title or Position : SOLE MBR
Name : MATHEW RYAN O'CONNOR
Credential : LCMHC/LCAS
Telephone Number : 646-872-7527
Provider Enumeration Date : 10/25/2022
Last Update Date : 12/05/2025

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