Healthcare Provider Details

I. General information

NPI: 1134041940
Provider Name (Legal Business Name): SKYLINE WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4921 ALBEMARLE RD STE 202
CHARLOTTE NC
28205-6654
US

IV. Provider business mailing address

1310 MAY APPLE DR
MATTHEWS NC
28104-1139
US

V. Phone/Fax

Practice location:
  • Phone: 754-270-3734
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: OLEKSANDR TALALENKO
Title or Position: OWNER
Credential:
Phone: 754-270-3734