Healthcare Provider Details

I. General information

NPI: 1649938390
Provider Name (Legal Business Name): MICHAL KRZYSZTOF SZELWACH PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2021
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5160 OCEAN HWY W
SHALLOTTE NC
28470-4012
US

IV. Provider business mailing address

5160 OCEAN HWY W
SHALLOTTE NC
28470-4012
US

V. Phone/Fax

Practice location:
  • Phone: 910-332-3800
  • Fax: 910-251-0421
Mailing address:
  • Phone: 910-332-3800
  • Fax: 910-251-0421

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: