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ANYA WALLACE PA-C
NPI 1609264373
Physician Assistant - Medical in Charlotte, NC

Active since January 05, 2015Opted out of Medicare · through Oct 1, 2027
309 S SHARON AMITY RD., SUITE 206, CHARLOTTE, NC 28211(704) 360-5018(980) 273-1102 Get Directions Write a Review

NPPES record last updated: July 14, 2021. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Anya Wallace Pa-c NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

ANYA WALLACE PA-C (NPI 1609264373) is an individual medical provider in Charlotte, North Carolina, licensed in North Carolina (0010-05473) and active in the NPI registry since January 2015. She has opted out of Medicare through October 1, 2027.

NPPES Registry Identity

NPI1609264373
Entity TypeIndividualFemale
Primary Taxonomy363AM0700X
Provider Legal NameANYA WALLACECredential: PA-C
Location Address309 S SHARON AMITY RD., SUITE 206Charlotte, NC 28211
Mailing Address309 S Sharon Amity Rd., Suite 206Charlotte, NC 28211 · (704) 360-5018 · Fax (980) 273-1102
Phone(704) 360-5018
Fax(980) 273-1102
Sole ProprietorYes
Enumeration DateJanuary 5, 2015
Last NPPES UpdateJuly 14, 2021
NPPES CertifiedJuly 14, 2021
✔ NPI 1609264373 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyPhysician Assistant · MedicalPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363AM0700X
License✔ Licensed in NC · 0010-05473
Also ListedPhysician AssistantTaxonomy 363A00000X · License 0010-05473 (NC)
309 S SHARON AMITY RD., Charlotte, NC 28211
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Anya Wallace Pa-c has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from October 1, 2021 through October 1, 2027.

Opt-Out Effective DateOctober 1, 2021
Opt-Out In Effect ThroughOctober 1, 2027Opt-out affidavits renew automatically every two years unless cancelled

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Anya Wallace's NPI number?

The NPI number for Anya Wallace is 1609264373. It was assigned to this individual provider in the NPPES registry on January 5, 2015.

Where is Anya Wallace located?

Anya Wallace practices at 309 S Sharon Amity Rd. Suite 206, Charlotte, NC 28211. The listed phone number is (704) 360-5018.

What is Anya Wallace's specialty?

The primary specialty registered for this NPI is Physician Assistant, specializing in Medical, with taxonomy code 363AM0700X.

Is Anya Wallace enrolled in Medicare?

No. Anya Wallace has opted out of Medicare through October 1, 2027. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out.

When was this NPI record last updated?

The NPPES record for Anya Wallace was last updated on July 14, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.