Provider Demographics
NPI:1487046280
Name:CARDUCCI, DARYL (PA-C)
Entity type:Individual
Prefix:
First Name:DARYL
Middle Name:
Last Name:CARDUCCI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 32003
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27622-2003
Mailing Address - Country:US
Mailing Address - Phone:919-297-0348
Mailing Address - Fax:919-297-0349
Practice Address - Street 1:101 LATTNER CT
Practice Address - Street 2:
Practice Address - City:MORRISVILLE
Practice Address - State:NC
Practice Address - Zip Code:27560-6843
Practice Address - Country:US
Practice Address - Phone:919-336-5663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-03
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-05619363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant