Healthcare Provider Details

I. General information

NPI: 1063153492
Provider Name (Legal Business Name): CHAZ AUSTIN CLUSKY PA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2022
Last Update Date: 06/30/2025
Certification Date: 06/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5601 ARRINGDON PARK DR STE 300
MORRISVILLE NC
27560-5677
US

IV. Provider business mailing address

5601 ARRINGDON PARK DR STE 300
MORRISVILLE NC
27560-5677
US

V. Phone/Fax

Practice location:
  • Phone: 919-660-5066
  • Fax:
Mailing address:
  • Phone: 919-660-5066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-15329
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number0010-15329
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: