Provider Demographics
NPI:1003217332
Name:AMILCKA, SHELDA (PA-C)
Entity Type:Individual
Prefix:
First Name:SHELDA
Middle Name:
Last Name:AMILCKA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:704-316-5000
Mailing Address - Fax:704-316-5010
Practice Address - Street 1:1900 RANDOLPH RD STE 300
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28207-1106
Practice Address - Country:US
Practice Address - Phone:704-384-6225
Practice Address - Fax:704-316-3825
Is Sole Proprietor?:No
Enumeration Date:2014-09-05
Last Update Date:2020-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-05218363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1003217332Medicaid
NCNCL264DMedicare PIN
NC1003217332Medicaid
NCNCL264CMedicare PIN
NCNCL264AMedicare PIN
NCNCL264BMedicare PIN
NCNCL264EMedicare PIN