MEDICARE: GABRIELLA COMUNALE DECOSTE PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	0010-15145	NC

General Provider Information

NPI Number	:	1306667480
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GABRIELLA COMUNALE DECOSTE PA-C

Provider Business Mailing Address
First Line	:	7349 STATESVILLE RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28269-3702
Country	:	US
Telephone Number	:	954-397-5926
Fax Number	:

Provider Business Practice Location Address
First Line	:	7349 STATESVILLE RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28269-3702
Country	:	US
Telephone Number	:	866-242-3814
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/21/2024
Last Update Date	:	12/01/2025

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