Healthcare Provider Details

I. General information

NPI: 1881246742
Provider Name (Legal Business Name): DYLAN JAMES PARACKA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2019
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 S SHARON AMITY RD
CHARLOTTE NC
28211-2896
US

IV. Provider business mailing address

400 CLARICE AVE APT 165
CHARLOTTE NC
28204-2635
US

V. Phone/Fax

Practice location:
  • Phone: 704-377-2424
  • Fax:
Mailing address:
  • Phone: 706-676-6126
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: