MEDICARE: DANIELLE TASHAKORI PA

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	363AM0700X	Medical Physician Assistant
2	363AM0700X	Medical Physician Assistant	001005115	NC

General Provider Information

NPI Number	:	1518217231
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIELLE TASHAKORI PA

Provider Business Mailing Address
First Line	:	719 EAST BLVD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28203-5113
Country	:	US
Telephone Number	:	704-376-9849
Fax Number	:	704-323-6023

Provider Business Practice Location Address
First Line	:	719 EAST BLVD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28203-5113
Country	:	US
Telephone Number	:	704-376-9849
Fax Number	:	704-323-6023

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

Provider Enumeration Date	:	09/11/2012
Last Update Date	:	04/18/2024

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Directions to “ DANIELLE TASHAKORI PA” Practice Location

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