Provider Demographics
NPI:1093142283
Name:SHARTLE, SAMANTHA RAE (PA)
Entity Type:Individual
Prefix:MS
First Name:SAMANTHA
Middle Name:RAE
Last Name:SHARTLE
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:PO BOX 601843
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-1843
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9600 E INDEPENDENCE BLVD STE B
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-4628
Practice Address - Country:US
Practice Address - Phone:704-815-5624
Practice Address - Fax:704-815-5621
Is Sole Proprietor?:No
Enumeration Date:2013-10-02
Last Update Date:2021-05-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC195581363A00000X
NC0010-04524363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant