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ETHAN TYLER MAHAFFEY
NPI 1679367700
Student in an Organized Health Care Education/Training Program in Charlotte, NC

Active since April 04, 2025PECOS Enrolled
1350 S KINGS DR FL 3, CHARLOTTE, NC 28207(704) 446-1242(704) 446-1241 Get Directions Write a Review

NPPES record last updated: April 4, 2025. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Ethan Tyler Mahaffey NPPES

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

ETHAN TYLER MAHAFFEY (NPI 1679367700) is an individual student in an organized health care education/training program in Charlotte, North Carolina and active in the NPI registry since April 2025. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1679367700
Entity TypeIndividualMale
Primary Taxonomy390200000X
Provider Legal NameETHAN TYLER MAHAFFEY
Location Address1350 S KINGS DR FL 3Charlotte, NC 28207-2134
Mailing Address2010 Country Trace Lane, Apt 11eToledo, OH 43615 · (419) 450-7079
Phone(704) 446-1242
Fax(704) 446-1241
Sole ProprietorNo
Enumeration DateApril 4, 2025
NPPES CertifiedApril 4, 2025
✔ NPI 1679367700 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care
Taxonomy Code390200000X
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
1350 S KINGS DR FL 3, Charlotte, NC 28207
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Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Ethan Tyler Mahaffey is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

WILLIAM DAVID LAIDIG
Student in an Organized Health Care Education/Training Program
1350 S KINGS DR FL 3
CHARLOTTE, NC 28207
Mecklenburg County (704) 446-1242
MARYAM ZOABI DO
Student in an Organized Health Care Education/Training Program
1350 S KINGS DR FL 3
CHARLOTTE, NC 28207
Mecklenburg County (704) 446-1242
ELAINE PATEL MD
Student in an Organized Health Care Education/Training Program
1350 S KINGS DR FL 3
CHARLOTTE, NC 28207
Mecklenburg County (704) 446-1242
DONALD ELLIS DEEP DO
Student in an Organized Health Care Education/Training Program
1350 S KINGS DR FL 3
CHARLOTTE, NC 28207
Mecklenburg County (704) 446-1242
PRIYANKA MOHANTY DO
Student in an Organized Health Care Education/Training Program
1350 S KINGS DR FL 3
CHARLOTTE, NC 28207
Mecklenburg County (704) 446-1242
VICTORIA MAE KONIUK DO
Student in an Organized Health Care Education/Training Program
1350 S KINGS DR FL 3
CHARLOTTE, NC 28207
Mecklenburg County (704) 446-1242
SARINA SHRESTHA MD
Student in an Organized Health Care Education/Training Program
1350 S KINGS DR FL 3
CHARLOTTE, NC 28207
Mecklenburg County (704) 446-1242
CAROLINE HORNE
Student in an Organized Health Care Education/Training Program
1350 S KINGS DR FL 3
CHARLOTTE, NC 28207
Mecklenburg County (704) 446-1242

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 Ethan Mahaffey's NPI number?

The NPI number for Ethan Mahaffey is 1679367700. It was assigned to this individual provider in the NPPES registry on April 4, 2025.

Where is Ethan Mahaffey located?

Ethan Mahaffey practices at 1350 S Kings Dr Fl 3, Charlotte, NC 28207. The listed phone number is (704) 446-1242.

What is Ethan Mahaffey's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Is Ethan Mahaffey enrolled in Medicare?

Yes. Ethan Mahaffey is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Ethan Mahaffey was last updated on April 4, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 months 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.