Healthcare Provider Details

I. General information

NPI: 1104748763
Provider Name (Legal Business Name): RYAN MARC SCHAFTEL CPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 BIRCHWOOD DR
CHARLOTTE NC
28214-1201
US

IV. Provider business mailing address

119 BIRCHWOOD DR
CHARLOTTE NC
28214-1201
US

V. Phone/Fax

Practice location:
  • Phone: 443-691-4557
  • Fax:
Mailing address:
  • Phone: 443-691-4557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: