Healthcare Provider Details

I. General information

NPI: 1003407701
Provider Name (Legal Business Name): AMY SUZANNE BUERY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2021
Last Update Date: 03/24/2025
Certification Date: 03/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7903 PROVIDENCE RD STE 100
CHARLOTTE NC
28277-9763
US

IV. Provider business mailing address

PO BOX 60447
CHARLOTTE NC
28260-0447
US

V. Phone/Fax

Practice location:
  • Phone: 704-316-4460
  • Fax: 704-316-4466
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-11887
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: