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General NPI Number Information
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NPI Number | 1114915790
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Entity Type | Individual
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Provider Name | MICHAEL SIERACKI PA-C
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Gender | Male
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Dates
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Enumeration Date | 10/08/2005
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Last Update Date | 10/16/2024
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Provider Practice Location Address
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Address Line | 400 NASH MEDICAL ARTS MALL
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City | ROCKY MOUNT
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State | NC
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Zip | 27804-1415
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Country | US
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Telephone | 252-962-5300
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Fax | 252-962-5309
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Provider Business Mailing Address
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Address Line | 5221 PARAMOUNT PKWY STE 220
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City | MORRISVILLE
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State | NC
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Zip | 27560-5490
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 0010-01048
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 0054831
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 0010-01048
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License Number State | NC
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