Healthcare Provider Details

I. General information

NPI: 1720403694
Provider Name (Legal Business Name): TAMRA SHAY CHEEK PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2014
Last Update Date: 11/26/2024
Certification Date: 11/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2635 LAWNDALE DR
GREENSBORO NC
27408-4802
US

IV. Provider business mailing address

PO BOX 601843
CHARLOTTE NC
28260-1843
US

V. Phone/Fax

Practice location:
  • Phone: 336-867-4310
  • Fax: 336-867-4311
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-04865
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: