MEDICARE: DYLAN JAMES PARACKA

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	2255A2300X	Athletic Trainer
2	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1881246742
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DYLAN JAMES PARACKA

Provider Business Mailing Address
First Line	:	400 CLARICE AVE APT 165
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28204-2635
Country	:	US
Telephone Number	:	706-676-6126
Fax Number	:

Provider Business Practice Location Address
First Line	:	501 S SHARON AMITY RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28211-2896
Country	:	US
Telephone Number	:	704-377-2424
Fax Number	:

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

Provider Enumeration Date	:	07/11/2019
Last Update Date	:	12/08/2025

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