Provider Demographics
NPI:1033796099
Name:HORBACZEWSKI, ALYSIA SHANNON (MD)
Entity Type:Individual
Prefix:
First Name:ALYSIA
Middle Name:SHANNON
Last Name:HORBACZEWSKI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ALYSIA
Other - Middle Name:SHANNON
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1000 BLYTHE BLVD FL 4
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28203-5812
Mailing Address - Country:US
Mailing Address - Phone:704-381-6800
Mailing Address - Fax:704-381-6841
Practice Address - Street 1:1000 BLYTHE BLVD FL 4
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-5812
Practice Address - Country:US
Practice Address - Phone:704-381-6800
Practice Address - Fax:704-381-6841
Is Sole Proprietor?:No
Enumeration Date:2021-03-25
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHORB-ZXTY4O208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics