Individual
MRS. MICHELLE MARIE MATARESE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
197 PIEDMONT BLVD STE 100, ROCK HILL, SC 29732-1825
(803) 324-1950
(803) 324-1933
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
(704) 316-5100
(704) 316-5101
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
1463
MA
363A00000X
Physician Assistant
Primary
2930
SC
363AS0400X
Surgical Physician Assistant
0010-01206
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1316044266
—
NC
Enumeration date
09/20/2006
Last updated
08/21/2025
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