Healthcare Provider Details

I. General information

NPI: 1285669804
Provider Name (Legal Business Name): SHARON MCVAY O'BRIEN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 06/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14215 BALLANTYNE CORPORATE PL SUITE 230
CHARLOTTE NC
28277-3670
US

IV. Provider business mailing address

PO BOX 60447
CHARLOTTE NC
28260-0447
US

V. Phone/Fax

Practice location:
  • Phone: 704-316-5000
  • Fax: 704-316-5010
Mailing address:
  • Phone: 704-316-5000
  • Fax: 704-316-5010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0010-00044
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-00044
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: