Provider Demographics
NPI:1376564104
Name:SICELOFF, ERIN PARSONS (PA-C)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:PARSONS
Last Name:SICELOFF
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 1:1918 RANDOLPH RD STE 600
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28207-1198
Mailing Address - Country:US
Mailing Address - Phone:704-342-0252
Mailing Address - Fax:980-533-7806
Practice Address - Street 1:1918 RANDOLPH RD STE 600
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28207-1198
Practice Address - Country:US
Practice Address - Phone:704-342-0252
Practice Address - Fax:980-533-7801
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-00335363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q59446Medicare UPIN
Q59446Medicare UPIN